LeCouffe NE, Kappelhof M, Treurniet KM, et al. - Findings demonstrate neither superiority nor noninferiority of endovascular treatment (EVT) alone to intravenous alteplase followed by EVT regarding disability outcome at 90 days post-stroke in European patients. Both groups had similar incidence of symptomatic intracerebral hemorrhage.

• In this open-label, multicenter, randomized trial in Europe, a total of 539 patients with stroke who presented directly to a hospital that was capable of providing EVT and who were eligible for intravenous alteplase and EVT were included.

• Patients were randomized to receive EVT alone or intravenous alteplase followed by EVT (the standard of care).

• At 90 days, median score on the modified Rankin scale was 3 (interquartile range, 2 to 5) vs 2 (interquartile range, 2 to 5) with EVT alone vs with alteplase plus EVT, respectively.

• Adjusted common odds ratio was 0.84 (P=0.28), which displayed neither superiority nor noninferiority of EVT alone.

• In the EVT alone group, mortality was 20.5%, and it was 15.8% with alteplase plus EVT (adjusted odds ratio, 1.39; 95% CI, 0.84 to 2.30).