A multicenter, randomized, controlled study to investigate extending the time for thrombolysis in emergency neurological deficits with intra-arterial therapy (EXTEND-IA)

Background and Hypothesis: Thrombolysis with tissue plasminogen activator is proven to reduce disability when given within 4·5h of ischemic stroke onset. However, tissue plasminogen activator only succeeds in recanalizing large vessel arterial occlusion in a minority of patients. We hypothesized that anterior circulation ischemic stroke patients, selected with 'dual target' vessel occlusion and evidence of salvageable brain using computed tomography or magnetic resonance imaging 'mismatch' within 4·5h of onset, would have improved reperfusion and early neurological improvement when treated with intra-arterial clot retrieval after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone. Study Design: EXTEND-IA is an investigator-initiated, phase II, multicenter prospective, randomized, open-label, blinded-endpoint study. Ischemic stroke patients receiving standard 0·9mg/kg intravenous tissue plasminogen activator within 4·5h of stroke onset who have good prestroke functional status (modified Rankin Scale 1·2, absolute mismatch >10ml, ischemic core volum