Thrombectomy Beats Clot-Busting Drugs in Extended-Window Stroke, Landmark

A Bayesian network meta-analysis in the Journal of Neurology argues that for patients treated in the extended time window after ischemic stroke onset, mechanical clot removal performs best for those with confirmed blockages in the brain’s largest arteries. Led by Wenkui Li and colleagues at Chongqing University Three Gorges Hospital, the study pooled data from 15 randomized trials using reperfusion therapies between 4.5 and 24 hours after stroke onset (or the last known well time). Compared with clot-busting drugs—tenecteplase and alteplase—or bridging therapy (drugs plus thrombectomy), the analysis found no clear improvement from adding thrombolytics for large-vessel occlusion (LVO) or basilar artery cases. The primary outcome was functional independence at 90 days, measured by a modified Rankin Scale score of 0 to 2.