NINDS 1995
Question
Does IV alteplase given within 3 hours of ischemic stroke onset improve outcomes?
Bottom line
Yes — absolute increase in favorable outcomes despite a higher symptomatic ICH rate. Established IV thrombolysis as standard of care.
The Library
Landmark stroke trials.
A growing reference of the trials that shaped how stroke is treated — one paragraph each, organized by the question they answered. Deeper articles link out where they exist.
Educational summaries only
These are short reference summaries — consult the primary sources for clinical decisions.
§ 01 · Thrombolysis
Acute IV reperfusion.
ECASS III 2008
Question
Does IV alteplase work in the 3 to 4.5 hour window?
Bottom line
Yes — modestly improved outcomes. Extended the treatment window to 4.5 hours.
§ 02 · Thrombectomy
Endovascular therapy.
MR CLEAN 2015
Question
Does mechanical thrombectomy plus standard care beat standard care alone in anterior-circulation LVO?
Bottom line
Yes — dramatically. First positive modern thrombectomy trial. Opened the era of EVT.
ESCAPE 2015
Question
EVT with rapid workflow and CT-angiography-based selection out to 12 hours.
Bottom line
Substantial benefit. Reinforced the role of imaging-guided selection and fast workflow.
SWIFT PRIME 2015
Question
Solitaire stent retriever in anterior LVO within 6 hours.
Bottom line
Significant functional benefit. Confirmed stent-retriever EVT in the early window.
EXTEND-IA 2015
Question
EVT with CT-perfusion-based selection (small core, large penumbra) within 6 hours.
Bottom line
Strongly positive. Established the value of perfusion imaging to identify salvageable tissue.
HERMES 2016
Question
Pooled individual-patient meta-analysis of the five 2015 EVT trials.
Bottom line
NNT roughly 2.6 for 1-point mRS improvement. Cemented EVT as one of the most effective treatments in medicine.
§ 03 · Late window
Extending the clock.
DAWN 2018
Question
EVT in the 6 to 24 hour window using clinical-core mismatch.
Bottom line
Profoundly positive. NNT roughly 2 for functional independence. Opened the late window.
DEFUSE 3 2018
Question
EVT in the 6 to 16 hour window using perfusion-imaging mismatch.
Bottom line
Strongly positive. Confirmed the perfusion-imaging selection approach in the late window.
§ 04 · Large core
Beyond the small core.
RESCUE-Japan LIMIT 2022
Question
EVT for large-core ischemic stroke (ASPECTS 3-5).
Bottom line
Better outcomes with EVT despite a higher ICH rate. First positive large-core trial.
SELECT2 2023
Question
EVT for large-core anterior LVO (ASPECTS 3-5 or core ≥ 50 mL).
Bottom line
Significant benefit with EVT. Helped extend EVT eligibility into larger cores.
ANGEL-ASPECT 2023
Question
EVT in large-core anterior LVO (ASPECTS 3-5) within 24 hours.
Bottom line
Positive. Reinforced EVT benefit in selected large-core strokes.
TENSION 2023
Question
EVT vs medical management in large-core anterior LVO (ASPECTS 3-5).
Bottom line
Stopped early for benefit. Consistent with SELECT2 and ANGEL-ASPECT.
§ 05 · Anticoagulation
When to start AC after AFib stroke.
ELAN 2023
Question
Early vs late initiation of DOAC after ischemic stroke with atrial fibrillation.
Bottom line
Early DOAC was non-inferior — numerically favored — for the composite of recurrent stroke and bleeding. Supports earlier anticoagulation in selected patients.
OPTIMAS 2024
Question
Early (≤ 4 days) vs delayed DOAC after ischemic stroke with AFib.
Bottom line
Early was non-inferior. Together with ELAN, supports shifting toward earlier DOAC initiation in most patients.
§ 06 · At the bedside
The instruments these trials standardized.
Every trial above reports outcomes in the same currency — an mRS at 90 days, an ASPECTS on the baseline CT, an NIHSS at the door. Those scales left the trials and became the bedside vocabulary.
Modified Rankin Scale
The 0–6 disability scale behind every "shift analysis" and every reported good outcome in the trials above.
ASPECTS
The 10-point CT score that defined who counted as large core in SELECT2, ANGEL-ASPECT, and RESCUE-Japan LIMIT.
NIHSS
The entry criterion and severity measure used across the thrombolysis and thrombectomy trials.
Thrombectomy eligibility
What DAWN, DEFUSE 3, and the large-core trials add up to at the bedside, window by window.
Door-to-needle workflow
The workflow that turns a positive thrombolysis trial into a treated patient in under 60 minutes.
Acute blood pressure targets
The thresholds that govern the hours after the trials above end and management begins.
The library will keep growing. Suggest a trial that should be added — or one that's been miscategorized — via the contact page.