***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 BACKGROUND In patients with ischemic stroke , endovascular treatment results in a higher rate of recanalization of the affected cerebral artery than systemic intravenous thrombolytic therapy . However , comparison of the clinical efficacy of the two approaches is needed . METHODS We r and omly assigned 362 patients with acute ischemic stroke , within 4.5 hours after onset , to  endovascular therapy ( intraarterial thrombolysis with recombinant tissue plasminogen activator [ t-PA ] , mechanical clot disruption or retrieval , or a combination of these approaches ) or intravenous t-PA . Treatments were to be given as soon as possible after r and omization . The primary outcome was survival free of disability ( defined as a modified Rankin score of 0 or 1 on a scale of 0 to 6 , with 0 indicating no symptoms , 1 no clinical ly significant disability despite symptoms , and 6 death ) at 3 months . RESULTS A total of 181 patients were assigned to receive endovascular therapy , and 181 intravenous t-PA .  The median time from stroke onset to the start of treatment was 3.75 hours for endovascular therapy and 2.75 hours for intravenous t-PA ( P<0.001 ) . At 3 months , 55 patients in the endovascular-therapy group ( 30.4 % ) and 63 in the intravenous t-PA group ( 34.8 % ) were alive without disability ( odds ratio adjusted for age , sex , stroke severity , and atrial fibrillation status at baseline , 0.71 ; 95 % confidence interval , 0.44 to 1.14 ; P=0.16 ) . Fatal or nonfatal symptomatic intracranial hemorrhage within 7 days occurred in 6 % of the patients in each group , and there were no significant differences between groups in the rates of other serious adverse events or the case fatality rate . CONCLUSIONS The results of this trial in patients with acute ischemic stroke indicate that endovascular therapy is not superior to st and ard treatment with intravenous t-PA . ( Funded by the Italian Medicines Agency , Clinical Trials.gov number , NCT00640367 . ) IMPORTANCE R and omized clinical trials suggest the benefit of intravenous tissue-type plasminogen activator ( tPA ) in acute ischemic stroke is time dependent . However , modest sample sizes have limited characterization of the extent to which onset to treatment ( OTT ) time influences outcome ; and the generalizability of findings to clinical practice is uncertain . OBJECTIVE To evaluate the degree to which OTT time is associated with outcome among patients with acute ischemic stroke treated with intraveneous tPA . DESIGN , SETTING , AND PATIENTS Data were analyzed from 58,353 patients with acute ischemic stroke treated with tPA within 4.5 hours of symptom onset in 1395 hospitals participating in the Get With The Guidelines -Stroke Program , April 2003 to March 2012 . MAIN OUTCOMES AND MEASURES Relationship between OTT time and in-hospital mortality , symptomatic intracranial hemorrhage , ambulatory status at discharge , and discharge destination . RESULTS Among the 58,353 tPA-treated patients , median age was 72 years , 50.3 % were women , median OTT time was 144 minutes ( interquartile range , 115 - 170 ) , 9.3 % ( 5404 ) had OTT time of 0 to 90 minutes , 77.2 % ( 45,029 ) had OTT time of 91 to 180 minutes , and 13.6 % ( 7920 ) had OTT time of 181 to 270 minutes . Median pretreatment National Institutes of Health Stroke Scale documented in 87.7 % of patients was 11 ( interquartile range , 6 - 17 ) . Patient factors most strongly associated with shorter OTT included greater stroke severity ( odds ratio [ OR ] , 2.8 ; 95 % CI , 2.5 - 3.1 per 5-point increase ) , arrival by ambulance ( OR , 5.9 ; 95 % CI , 4.5 - 7.3 ) , and arrival during regular hours ( OR , 4.6 ; 95 % CI , 3.8 - 5.4 ) . Overall , there were 5142 ( 8.8 % ) in-hospital deaths , 2873 ( 4.9 % ) patients had intracranial hemorrhage , 19,491 ( 33.4 % ) patients achieved independent ambulation at hospital discharge , and 22,541 ( 38.6 % ) patients were discharged to home . Faster OTT , in 15-minute increments , was associated with reduced in-hospital mortality ( OR , 0.96 ; 95 % CI , 0.95 - 0.98 ; P < .001 ) , reduced symptomatic intracranial hemorrhage ( OR , 0.96 ; 95 % CI , 0.95 - 0.98 ; P < .001 ) , increased achievement of independent ambulation at discharge ( OR , 1.04 ; 95 % CI , 1.03 - 1.05 ; P < .001 ) , and increased discharge to home ( OR , 1.03 ; 95 % CI , 1.02 - 1.04 ; P < .001 ) . CONCLUSIONS AND RELEVANCE In a registry representing US clinical practice , earlier thrombolytic treatment was associated with reduced mortality and symptomatic intracranial hemorrhage , and higher rates of independent ambulation at discharge and discharge to home following acute ischemic stroke . These findings support intensive efforts to accelerate hospital presentation and thrombolytic treatment in patients with stroke 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 
    Output:
    
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 ischaemic stroke within 6 hours after symptom onset .
We found moderate quality of evidence to recommend MT plus BMM in the 6 - 24h time window in patients meeting the eligibility criteria of published r and omized trials .
Conclusions MT is the st and ard of care in patients with LVO-related acute stroke .