Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Intra-arterial Thrombectomy as an Acute Treatment Intervention for Stoke: the Endovascular Acute Stoke Intervention (EASI) Trial
Brief Summary: Stroke constitutes the primary cause of acquired disability in adults and the second cause of dementia following Alzheimer disease. It has been shown that patients with a moderate to severe clinical score have occlusion of brain large vessels, resulting in a worse clinical outcome. Many studies have demonstrated that early recanalization after IV rtPA is more restricted, the larger and more proximal the artery. Several systems for mechanical intracranial arterial thrombectomy of large trunks have recently been proposed and are now available. Potential advantages of these mechanical systems on chemical thrombolysis are speed (a few minutes versus 1 hour) and absence of thrombolytic injection.

The objective of the EASI trial is thus to:

* To validate intra-arterial thrombectomy use during the acute phase of cerebral stroke in patients treated with IV thrombolysis or in patients for whom thrombolysis is contra-indicated.
* To determine whether a combined approach, standard treatment plus thrombectomy, is superior to standard treatment alone within 5 h of the appearance of symptoms, in patients with occlusion of proximal cerebral arteries following moderate to severe stroke (NIHSS larger than or equal to 8), evaluated at 3 months.

The design is a randomized, controlled multicentric trial, with a parallel comparison between standard and combined (standard plus thrombectomy) treatment.

480 patients fulfilling eligibility criteria will be sufficient to demonstrate the primary hypothesis of a 15% difference in number of subjects with a favorable mRS (less than or equal to 2) at 3 months, with the assumption of a 25% efficacy for IV thrombolytic treatment at 3 months.

IV thrombolysis is carried out according to standard practice. Mechanical thrombectomy is carried out with already approved devices, according to the manufacturer's instructions, following a diagnostic cerebral angiography.

The primary efficacy endpoint is clinical: favorable mRS (less than or equal to 2) at 3 months.

The primary safety endpoint is rate of death at 3 months and rate of symptomatic hemorrhage at 24 hours.

If the primary hypothesis is validated, expected benefits of this study is a higher rate of autonomy for stroke patients with all the attendant consequences: reduction in hospital stays, and a faster return to the activities of daily life.


Options:
A: Arm Label: Intra-arterial Clot Retrieval after iv tPA; Type: EXPERIMENTAL; Interventions: Device: Intra-arterial Clot Retrieval with Solitaire device | Arm Label: Standard care iv tPA; Type: ACTIVE_COMPARATOR; Interventions: Genetic: intravenous tissue plasminogen activator (tPA) | Intervention Type: DEVICE; Name: Intra-arterial Clot Retrieval with Solitaire device; Assigned to Arm(s): Intra-arterial Clot Retrieval after iv tPA | Intervention Type: GENETIC; Name: intravenous tissue plasminogen activator (tPA); Assigned to Arm(s): Standard care iv tPA
B: Arm Label: 1; Type: EXPERIMENTAL; Interventions: Drug: IV tpa (Alteplase) vs IA tpa (Alteplase) | Arm Label: 2; Type: ACTIVE_COMPARATOR; Interventions: Drug: IV tpa (Alteplase) vs IA tpa (Alteplase) | Intervention Type: DRUG; Name: IV tpa (Alteplase) vs IA tpa (Alteplase); Assigned to Arm(s): 1, 2
C: Arm Label: Best standard treatment; Type: ACTIVE_COMPARATOR; Interventions: Drug: Best standard treatment | Arm Label: Mechanical thrombectomy; Type: ACTIVE_COMPARATOR; Interventions: Procedure: mechanical thrombectomy | Intervention Type: PROCEDURE; Name: mechanical thrombectomy; Assigned to Arm(s): Mechanical thrombectomy | Intervention Type: DRUG; Name: Best standard treatment; Assigned to Arm(s): Best standard treatment
D: Arm Label: Intravenous rtPA; Type: ACTIVE_COMPARATOR; Interventions: Drug: Intravenous rtPA | Arm Label: Intravenous rtPA and Mechanical Thrombectomy; Type: EXPERIMENTAL; Interventions: Device: Mechanical thrombectomy, Drug: Intravenous rtPA | Intervention Type: DEVICE; Name: Mechanical thrombectomy; Assigned to Arm(s): Intravenous rtPA and Mechanical Thrombectomy | Intervention Type: DRUG; Name: Intravenous rtPA; Assigned to Arm(s): Intravenous rtPA, Intravenous rtPA and Mechanical Thrombectomy

Answer: C