***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective The Pragmatic Ischaemic Thrombectomy Evaluation ( PISTE ) trial was a multicentre , r and omised , controlled clinical trial comparing intravenous thrombolysis ( IVT ) alone with IVT and adjunctive intra-arterial mechanical thrombectomy ( MT ) in patients who had acute ischaemic stroke with large artery occlusive anterior circulation stroke confirmed on CT angiography ( CTA ) . Design Eligible patients had IVT started within 4.5 hours of stroke symptom onset . Those r and omised to additional MT underwent thrombectomy using any Conformité Européene (CE)-marked device , with target interval times for IVT start to arterial puncture of < 90 min . The primary outcome was the proportion of patients achieving independence defined by a modified Rankin Scale ( mRS ) score of 0–2 at day 90 . Results Ten UK centres enrolled 65 patients between April 2013 and April 2015 . Median National Institutes of Health Stroke Scale score was 16 ( IQR 13–21 ) . Median stroke onset to IVT start was 120 min . In the intention-to-treat analysis , there was no significant difference in disability-free survival at day 90 with MT ( absolute difference 11 % , adjusted OR 2.12 , 95 % CI 0.65 to 6.94 , p=0.20 ) . Secondary analyses showed significantly greater likelihood of full neurological recovery ( mRS 0–1 ) at day 90 ( OR 7.6 , 95 % CI 1.6 to 37.2 , p=0.010 ) . In the per- protocol population ( n=58 ) , the primary and most secondary clinical outcomes significantly favoured MT ( absolute difference in mRS 0–2 of 22 % and adjusted OR 4.9 , 95 % CI 1.2 to 19.7 , p=0.021 ) . Conclusions The trial did not find a significant difference between treatment groups for the primary end point . However , the effect size was consistent with published data and across primary and secondary end points . Proceeding as fast as possible to MT after CTA confirmation of large artery occlusion on a background of intravenous alteplase is safe , improves excellent clinical outcomes and , in the per- protocol population , improves disability-free survival . Trial registration number NCT01745692 ; Results Background and Purpose — Imaging findings can predict outcomes in patients with acute stroke . Relationships between imaging findings and clinical and imaging outcomes in patients r and omized to intravenous tissue-type plasminogen activator – alone versus tissue-type plasminogen activator plus endovascular therapy ( Solitaire device ) in the Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke ( SWIFT PRIME ) study were assessed . Methods — We evaluated associations between imaging assessment s ( baseline mismatch profiles/ischemic core volumes and successful reperfusion ) with imaging outcomes ( 27-hour infa rct volume/growth ) and clinical outcomes ( modified Rankin Scale scores at 90 days ) . Imaging variables that predict favorable clinical outcomes were assessed in both univariate and multivariate models . Results — One hundred and ninety-five patients were included .  Successful reperfusion and infa rct volume ( assessed at 27 hours ) were powerful independent predictors of favorable clinical outcomes ( modified Rankin Scale score of 0–2 at 90 days ) . Patients with the target mismatch profile at baseline had a higher rate of reperfusion , lesser infa rct growth , smaller infa rct volumes , and better clinical outcomes in the Solitaire plus tissue-type plasminogen activator ( intervention ) group than those in the tissue-type plasminogen activator – alone ( control ) group . Patients with larger mismatch volumes at baseline had a trend toward better treatment response in the intervention group than patients who had smaller ( < 50 mL ) mismatch volumes . Conclusions — Patients who achieved reperfusion had substantially more favorable clinical and imaging outcomes in both the intervention and the control groups . Infa rct volume at 27 hours strongly correlated with clinical outcome at 90 days in both treatment groups . SWIFT PRIME patients with the target mismatch profile had a highly favorable response to endovascular therapy on both clinical and imaging outcomes . Both reperfusion and infa rct volumes at 27 hours were powerful and independent predictors of 90-day clinical outcomes . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01657461 Introduction The minimal stroke severity justifying endovascular intervention remains elusive ; however , a significant proportion of patients presenting with large vessel occlusion ( LVO ) and mild symptoms subsequently decline and face poor outcomes . Objective To evaluate our experience with these patients by comparing best medical therapy with thrombectomy in an intention-to-treat analysis . Methods Analysis of prospect ively collected data of all consecutive patients with National Institutes of Health Stroke Scale ( NIHSS ) score ≤5 , LVO on CT angiography , and baseline modified Rankin Scale ( mRS ) score 0–2 from November 2014 to May 2016 . After careful discussion with patients /family , a decision to pursue medical or interventional therapy was made . Deterioration ( development of aphasia , neglect , and /or significant weakness ) triggered reconsideration of thrombectomy . The primary outcome measure was NIHSS shift ( discharge NIHSS score minus admission NIHSS score ) . Results Of the 32 patients qualifying for the study , 22 ( 69 % ) were primarily treated with medical therapy and 10 ( 31 % ) intervention . Baseline characteristics were comparable . Nine ( 41 % ) medically treated patients had subsequent deterioration  requiring thrombectomy . Median time from arrival to deterioration was 5.2 hours ( 2.0–25.0 ) . Successful reperfusion ( modified Treatment in Cerebral Infa rct ion 2b−3 ) was achieved in all 19 thrombectomy patients . The NIHSS shift significantly favored thrombectomy ( −2.5 vs 0 ; p<0.01 ) . The median NIHSS score at discharge was low with both thrombectomy ( 1 ( 0–3 ) ) and medical therapy ( 2 ( 0.5–4.5 ) ) . 90-Day mRS 0–2 rates were 100 % and 77 % , respectively ( p=0.15 ) . Multivariable linear regression indicated that thrombectomy was independently associated with a beneficial NIHSS shift ( unst and ardized β −4.2 ( 95 % CI −8.2 to −0.1 ) ; p=0.04 ) . Conclusions Thrombectomy led to a shift towards a lower NIHSS in patients with LVO presenting with minimal stroke symptoms . Despite the overall perception that this condition is benign , nearly a quarter of patients primarily treated with medical therapy did not achieve independence at 90 days Background and objective Acute ischemic stroke is a potentially devastating condition and leading cause of morbidity and mortality , affecting an estimated 800 000 people per year in the USA . The natural history of untreated or unrevascularized large vessel occlusions in acute stroke patients results in mortality rates approaching 30 % , with only 25 % achieving good neurologic outcomes at 90 days . Recently , data have demonstrated that early endovascular recanalization of large vessel occlusions results in better outcomes than medical therapy alone . However , the majority of patients in these studies were treated with a stent retriever based approach . The purpose of COMPASS is to evaluate whether patients treated with a direct aspiration first pass ( ADAPT ) approach have non-inferior functional outcomes to those treated with a stent retriever as the firstline ( SRFL ) approach . Material s and methods All patients who meet the inclusion and exclusion criteria and consent to participate will be enrolled at participating centers . Treatment will be r and omly assigned by a central web based system in a 1:1 manner to treatment with either ADAPT or SRFL thrombectomy . Statistical methodology is prespecified with details available in the statistical analysis plan . Results The trial recently completed enrollment , and data collection /verification is ongoing . The final results will be made available on completion of enrollment and follow-up . Conclusions This paper details the design of the COMPASS trial , a r and omized , blinded adjudicator , concurrent , controlled trial of patients treated with either ADAPT or SRFL approaches in order to evaluate whether ADAPT results in non-inferior functional outcome . Trial registration number NCT02466893 , Results Background and Purpose — In acute ischemic stroke , fast and complete recanalization of the occluded vessel is associated with improved outcomes . We describe a novel measure for newer generation devices : the first pass effect ( FPE ) . FPE is defined as achieving a complete recanalization with a single thrombectomy device pass . Methods — The North American Solitaire Acute Stroke Registry data base was used to identify a FPE subgroup . Their baseline features and clinical outcomes were compared with non-FPE patients . Clinical outcome measures included 90-days modified Rankin Scale score , National Institutes of Health Stroke Scale score , mortality , and symptomatic intracranial hemorrhage . Multivariate analyses were performed to determine whether FPE independently result ed in improved outcomes and to identify predictors of FPE . Results — A total of 354 acute ischemic stroke patients underwent thrombectomy in the North American Solitaire Acute Stroke registry . FPE was achieved in 89 out of 354 ( 25.1 % ) . More middle cerebral artery occlusions ( 64 % versus 52.5 % ) and fewer internal carotid artery occlusions ( 10.1 % versus 27.7 % ) were present in the FPE group . Balloon guide catheters were used more frequently with FPE ( 64.0 % versus 34.7 % ) . Median time to revascularization was significantly faster in the FPE group ( median 34 versus 60 minutes ; P=0.0003 ) . FPE was an independent predictor of good clinical outcome ( modified Rankin Scale score ⩽2 was seen in 61.3 % in FPE versus 35.3 % in non-FPE cohort ; P=0.013 ; odds ratio , 1.7 ; 95 % confidence interval , 1.1–2.7 ) . The independent predictors of achieving FPE were use of balloon guide catheters and non-internal carotid artery terminus occlusion . Conclusions — The achievement of complete revascularization from a single Solitaire thrombectomy device pass ( FPE ) is associated with significantly higher rates of good clinical outcome . The FPE is more frequently associated with the use of balloon guide catheters and less likely to be achieved with internal carotid artery terminus occlusion Background and Purpose — The Los Angeles Motor Scale ( LAMS ) is a 3-item , 0- to 10-point motor stroke-deficit scale developed for prehospital use . We assessed the convergent , divergent , and predictive validity of the LAMS when performed by paramedics in the field at multiple sites in a large and diverse geographic region . Methods — We analyzed early assessment and outcome data prospect ively gathered in the FAST-MAG trial ( Field Administration of Stroke Therapy – Magnesium phase 3 ) among patients with acute cerebrovascular disease ( cerebral ischemia and intracranial hemorrhage ) within 2 hours of onset , transported by 315 ambulances to 60 receiving hospitals . Results — Among 1632 acute cerebrovascular disease patients ( age 70±13 years , male 57.5 % ) , time from onset to prehospital LAMS was median 30 minutes ( interquartile range 20–50 ) , onset to early postarrival ( EPA ) LAMS was 145 minutes ( interquartile range 119–180 ) , and onset to EPA National Institutes of Health Stroke Scale was 150 minutes ( interquartile range 120–180 ) . Between the prehospital and EPA assessment s , LAMS scores were stable in 40.5 % , improved in 37.6 % , and worsened in 21.9 % . In tests of convergent validity , against the EPA National Institutes of Health Stroke Scale , correlations were r=0.49 for the prehospital LAMS and r=0.89 for the EPA LAMS . Prehospital LAMS scores did diverge from the prehospital Glasgow Coma Scale , r=−0.22 . Predictive accuracy ( adjusted C statistics ) for nondisabled 3-month outcome was as follows : prehospital LAMS , 0.76 ( 95 % confidence interval 0.74–0.78 ) ; EPA LAMS , 0.85 ( 95 % confidence interval 0.83–0.87 ) ; and EPA National Institutes of Health Stroke Scale , 0.87 ( 95 % confidence interval 0.85–0.88 ) . Conclusions — In this multicenter , prospect i ve , prehospital study , the LAMS showed good to excellent convergent , divergent , and predictive validity , further establishing it as a vali date d instrument to characterize stroke severity in the field Importance Intravenous thrombolysis ( IVT ) followed by mechanical thrombectomy ( MT ) is recommended to treat acute ischemic stroke ( AIS ) with a large vessel occlusion ( LVO ) . Most hospitals do not have on-site MT facilities , and most patients need to be transferred secondarily after IVT ( drip and ship ) , which may 
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RESULTS We found high- quality evidence to recommend MT plus best medical management ( BMM , including intravenous thrombolysis whenever indicated ) to improve functional outcome in patients with LVO-related acute ischemic stroke within 6 hours after symptom onset .
MT is the st and ard of care in patients with LVO-related acute stroke .