Welcome to part two of this journal jam podcast, Anton Hellman here. In part one, we covered the

world's most important literature on systemic IVLytics for stroke and concluded that actually

it's kind of difficult to draw any conclusions as to the benefit or harm of systemic IVLytics

for stroke because only two out of the 12 RCTs showed any benefit. There was a ton of bias in pretty much all the studies.

Many were stopped early, and the NINS trial, which seemed like a positive trial, never got

replicated. In this podcast, Justin Rory and I are going to review the RCTs on emergency

endovascular therapy for stroke. And just a heads up. The evolution and issues of the RCTs for the endovascular therapy for stroke. And just a heads up.

The evolution and issues of the RCTs for the endovascular therapies,

similar to the Ivy Lytics literature,

but the outcomes look quite a bit better

for a very small proportion of patients who suffer a stroke.

Music There's two main types of endovascular therapies.

There's intra-arterial TPA and there's mechanical thrombectomies to remove clots that are including brain arteries.

The pro-endovascular therapy folks out there claim that for some patients with proximal anterior circulation strokes, even though there's no mortality benefit, that there is a

significant functional outcome benefit at 90 days. In fact, three recent meta-analyses of

RCTs for endovascular therapy, one out of the Lancet, one out of the BMJ, and one out of

JAMA, all concluded that with a door to needle time under six

hours, endovascular therapy in addition to systemic litics improves outcomes without

increasing the risk of head bleats. Now that being said, the first few trials of endovascular

therapy were all negative, and it was only the later

studies that had stricter entry criteria that found positive results.

Now, that kind of sounds familiar to me.

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