6/28/23, 10:10 PM EXTEND-IA Pathway Feedback Search Clinical Topics Home Studies EXTEND IA EXTEND IA Disease Acute ischemic stroke Trial question Is endovascular therapy superior to alteplase in patients with ischemic stroke? Study design Multi-center Open label RCT Population Characteristics of study participants 51.0% female N = 70 49.0% male 70 patients (36 female, 34 male) Inclusion criteria: patients with a proximal cerebral arterial occlusion and salvageable tissue on CT perfusion imaging who were receiving alteplase Key exclusion criteria: pregnancy; intracranial hemorrhage; mRS score 2; rapidly improving symptoms; previous stroke within last 3 months; life expectancy < 1 year; current use of OACs Interventions N=35 endovascular therapy (endovascular thrombectomy with solitaire flow restoration stent retriever) N=35 alteplase only (continuation of alteplase alone at a dose of 0.9 mg/kg) Primary outcome Reperfusion at 24 hours 100.0 % 100 https://web.pathway.md/studies/recbLMzUdO3evxazH 1/2 6/28/23, 10:10 PM EXTEND-IA Pathway 75.0 % 50.0 % 37 Significant increase 25.0 % NNH = 2 0.0 % Endovascular therapy Alteplase only Significant increase in reperfusion at 24 hours (100% vs. 37%; OR 4.7, 95% CI 2.5 to 9) Secondary outcomes Significant increase in early neurologic improvement at day 3 (80% vs. 37%; OR 6, 95% CI 2 to 18) Significant decrease in reduction in mRS score at day 90 (1 vs. 3; OR 0.48, 95% CI 0.26 to 0.83) Significant increase in the percentage of patients achieving a modified Randkin scale score of 0-2 at day 90 (71% vs. 40%; OR 4.2, 95% CI 1.4 to 12) Safety outcomes No significant differences in death, sympatomatic intracerebral hemorrhage, parenchymal hematoma. Conclusion In patients with a proximal cerebral arterial occlusion and salvageable tissue on CT perfusion imaging who were receiving alteplase, endovascular therapy was superior to alteplase only with respect to reperfusion at 24 hours. Reference Bruce C V Campbell, Peter J Mitchell, Timothy J Kleinig et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015 Mar 12;372(11):1009-18. Open reference URL https://web.pathway.md/studies/recbLMzUdO3evxazH 2/2