European Recommendations on Organisation of Interventional Care in Acute Stroke (EROICAS)

Five recently published randomized controlled trials (RCTs) and respective meta-analyses provide strong evidence that endovascular thrombectomy (EVT) combined with best medical treatment, including intravenous (IV) tissue plasminogen activator (tPA) (IV thrombolysis, IVT) for eligible patients, improves the outcomes of appropriately selected patients with acute ischemic stroke in the setting of proximal occlusions in the carotid circulation (large vessel occlusion, LVO). Four out of the five studies were stopped early after a first RCT showed the superiority of EVT combined with medical management over medical management alone. Such premature trial termination will on average lead to overestimation of the treatment effect. Nonetheless, since all fiveRCTs showed consistent benefit of EVT over optimal medical management alone, and a dose–effect relation (reperfusion rates vs. clinical outcome), the benefit of EVT is considered established. After the publication of the ‘‘Consensus statement by ESO-Karolinska Stroke Update’’ as timely response to the new evidence, the purpose of EROICAS is to provide recommendations based on a structured collaborative process conducted by six relevant European professional societies.