Endovascular Therapy for Ischemic Stroke

Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), local investigators might have selected patients on the basis of findings on computed tomographic (CT) perfusion imaging, although such selection was not specified in the protocol. 2,3We compared the effect of endovascular therapy in patients with and in those without CT perfusion data.In 166 patients without such data, the adjusted common odds ratio for a favorable shift on the modified Rankin scale was 2.5 (95% confidence interval [CI], 1.4 to 4.5), as compared with 1.4 (95% CI, 1.0 to 2.1) in 334 patients with CT perfusion data.These numbers suggest that in MR CLEAN, the results for patients who had CT perfusion imaging were not better than those for patients without CT perfusion data.Although we very much appreciate the effort of the EXTEND-IA investigators in providing proof of principle that image selection leads to strong treatment effects, we would like to point out that their approach leaves us in the dark about the most effective clinical and imaging cutoff points in the selection of patients for endovascular treatment.