Endovascular thrombectomy after large-vessel ischaemic stroke

One-paragraph summary

HERMES pooled individual data for 1,287 participants from MR CLEAN, ESCAPE, REVASCAT, SWIFT PRIME, and EXTEND-IA. Thrombectomy reduced 90-day disability with adjusted common OR 2.49 (95% CI 1.76–3.53); one additional patient improved by at least one mRS level for every 2.6 treated. Prespecified subgroup interaction was not significant, and mortality, parenchymal hematoma, and symptomatic ICH did not differ (PMID 26898852).

Key findings

• 634 assigned thrombectomy and 653 control.
• Benefit persisted at age ≥80: common OR 3.68 (1.95–6.92).
• Benefit persisted when randomized >300 minutes: OR 1.76 (1.05–2.97).
• Benefit without IV-alteplase eligibility: OR 2.43 (1.30–4.55).

Limitations

• Trials primarily enrolled proximal anterior-circulation occlusion with imaging selection.
• Devices, workflows, anesthesia, and reperfusion standards have evolved.
• Absence of subgroup heterogeneity does not prove equal absolute benefit in every subgroup.

Why it matters

HERMES quantified thrombectomy's unusually large disability shift and supplied the evidence base for redesigning regional stroke systems around rapid LVO access.

Cited by wiki pages

• overview
• acute ischemic stroke
• stroke units and systems of care
• clinical trials landscape