Stroke Trials

	Year	Journal	Trial type	Key outcomes	Patient population	Intervention	Comparator	Outcome - Primary	Outcome secondary
INSPIRES	2023	NEJM	RCT	DAPT more effective than aspirin even if started out to 72hours post event	Mild stroke and high risk TIA Within 72 hours China	DAPT	Aspirin	New stroke 7.3% vs 9.2% HR 0.79	Bleeding 0.9% vs 0.4%	This is a similar trial and similar result to CHANCE and The main difference is that this trial allowed starting DAPT out to 72hours (vs 24hours).
CASSISS	2022	JAMA 328:534	RCT	Stenting not effective in ICAD	Patients With Symptomatic Intracranial Stenosis	Stenting (+ medical therapy)	Medical therapy	No difference in stroke of death within 30 days	No difference in stroke in the qualifying artery territory beyond 30 days through 1 year.
BAOCHE	2022	NEJM 387	RCT	ECR effective in basilar artery stroke out to 24hours	Stroke due to basilar-artery occlusion Presented at 6 to 24 hours	ECR	Medical Care	Higher percentage with good functional status at 90 days	Significant rate of procedural complications and more cerebral haemorrhages.
ATTENTION	2022	NEJM 387:1361	RCT	ECR effective in basilar artery stroke out to 12hours	Stroke due to basilar-artery occlusion Presented up to 12 hours	ECR	Medical care	Better functional outcomes at 90 days	Significant with procedural complications and intracerebral haemorrhage
BASICS	2021	NEJM 384:1910	RCT	ECR not effective in basilar artery stroke	Stroke due to basilar-artery occlusion	ECR	Medical Care	No difference
	Year	Journal	Trial type	Key outcomes	Patient population	Intervention	Comparator	Outcome - Primary	Outcome secondary
TREAT-CAD	2021	Lancet Neurology	RCT	Aspirin = Warfarin for cervical artery dissection	Symptomatic (stroke or local symptoms) cervical artery dissection	Warfarin (or phenprocoumon) Pts: 91	Aspirin Pts: 82	New stroke (clinical or MRI) at 90days Could not prove non-inferiority of aspirin (although there was an absolute increase of stroke in aspirin group ~7%)	No difference in final mRS scores	Subsequent post-hoc analysis study suggested benefit of warfarin in some subgroups
Stroke despite DOAC	2023	Neurology	Observational		Stroke while taking DOAC	Change DOAC Change to Warfarin Add antiplatelet	Continue DOAC Continue DOAC Continue DOAC	Increased stroke Increased stroke No difference		Association of Alternative Anticoagulation Strategies and Outcomes in Patients With Ischemic Stroke While Taking a Direct Oral Anticoagulant Yiu Ming Bonaventure Ip, Kui Kai Lau, Ho Ko, Lucas Lau, Alan Yao, Grace Lai-Hung Wong, Terry Cheuk-Fung Yip, Xinyi Leng, Howard Chan, Helen Chan, Vincent Mok, Yannie O.Y. Soo, David Seiffge, Thomas W Leung Neurology May 2023, 10
Stroke despite DOAC or warfarin	2022	JNNP	Observational		Stroke despite anticoagulation.	Warfarin or DOAC	Change warfarin to DOAC Different DOAC Add antiplatelet	Advantage. Changing No advantage Worse outcomes.		Aetiology, secondary prevention strategies and outcomes of ischaemic stroke despite oral anticoagulant therapy in patients with atrial fibrillation
SELECT2	2023	NEJM	RCT	ECR was superior to medical management on mRS outcomes.	Stroke in last 24hours with large core ASPECTS 3-5 Or Core >50ml on CTP USA, Australia, NZ			Primary outcome: Median mRS 4 vs 5 Secondary outcomes: mRS 0-2: 20.3% vs 7.0% sICH 0.6% vs 1.1%
ANGEL-ASPECT	2023	NEJM	RCT	Primary outcome: Median mRS 4 vs 4 Secondary outcomes: mRS 0-2: 30% vs 11.6% mRS 0-3: 47% vs 33.3% sICH 6.1% vs 2.7%	ECR for acute ischaemic stroke with large core Stroke in 24 hours LVO M1 or ICA Stroke in 24 hours ASPECTS 3-5 OR Stroke in 24 hours ASPECTS 0-2 and Core70-100ml OR Stroke 6-24hours: ASPECTS >5 and Core 70-100ml China Age 18-80 Avg 67			In patients with ischaemic stroke in last 24hours and large core (evidenced by low ASPECTS score or large infarct core on CTP) ECR was superior to medical management on mRS outcomes. There was a higher rate of sICH in ECR group.
ANNEXA-I	2024	NEJM	RCT	In patients with ICH taking factor Xa inhibitor given andexxa - Haematoma volume was reduced however disability was no different and there were more thrombotic events.	ICH in patient taking factor Xa inhibitor	Andexxa high dose or low dose	Placebo	Primary outcomes: Haematoma expansion <35% - 67% vs 53% NIHSS fall <7 – 87% vs 83% Thrombotic events 10.3% vs 5.6% Death 27.8% vs 25.5%