Key trials in neurology and stroke medicine for clinicians practising evidence-based medicine.
STROKE
TOPIC
SUB-TOPIC
THERAPY
TRIAL
Acute ischaemic stroke
Antiplatelet therapy
Dual antiplatelet therapy
ARAMIS
DAPT is non-inferior to alteplase (within 4.5h) in minor stroke in terms of functional outcome at 90 days.
Higher rate of bleeding events in Alteplase group.
ARAMIS
INSPIRES
Evidence for benefit of DAPT for up to 72 hours but with an increased risk of bleeding.
INSPIRES
POINT
Details coming soon.
POINT
Aspirin and clopidogrel combination reduce recurrent strokes in patients presenting with TIA/minor strokes, however with increased risk of haemorrhage.
CHANCE
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CHANCE
Aspirin and clopidogrel combination reduce recurrent strokes in patients presenting with TIA/minor strokes.
CHANCE II
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CHANCE II
Aspirin
CAST
Details coming soon.
CAST
IST
Details coming soon.
IST
Clopidogrel
CAPRIE
Details coming soon.
CAPRIE
Ticagrelor
THALES
Details coming soon.
THALES
Tirofiban
RESCUE BT2
IV tirofiban may improve 90-day outcomes after ischaemic stroke in some patient groups compared to oral aspirin.
RESCUE BT2
Atrial fibrillation
Timing of anticoagulation
OPTIMAS
Details coming soon.
OPTIMAS
Anticoagulation vs. placebo
BAATAF
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BAATAF
SPAF
Details coming soon.
SPAF
CAFA
Details coming soon.
CAFA
AFASAK
Details coming soon.
AFASAK
DOACs
RE-LY
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RE-LY
ARISTOTLE
Details coming soon.
ARISTOTLE
ROCKET AF
Details coming soon.
ROCKET AF
ENGAGE AF
Details coming soon.
ENGAGE AF
Embolic stroke of undetermined source
NAVIGATE-ESUS
Details coming soon.
NAVIGATE-ESUS
RESPECT-ESUS
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RESPECT-ESUS
ATTICUS
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ATTICUS
AF detection
STROKE-AF
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STROKE-AF
CRYSTAL-AF
Details coming soon.
CRYSTAL-AF
Thrombolysis
Alteplase 0-4.5 hrs
NINDs
Details coming soon.
NINDs
IV rTPA at 3 hours improved 3month clinical outcome, with excess of bleeding events.
PROACT-II
Details coming soon.
PROACT-II
IA r-proUK within 6 hours of the onset of acute ischemic stroke caused by MCA occlusion improved clinical outcome at 3 months.
ECASS III
Details coming soon.
ECASS III
As compared with placebo, intravenous alteplase administered between 3 and 4.5 hours improved clinical outcomes in patients with acute ischaemic stroke at expense of more ICH.
IST-3
Details coming soon.
IST-3
Thrombolysis within 6 h improved functional outcome, even in patients over 80 years old.
Alteplase 4.5-9 hrs
EXTEND
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EXTEND
Alteplase wake-up
WAKEUP
Details coming soon.
WAKEUP
TWIST
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TWIST
Tenecteplase vs. tPA
NOR-TEST
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NOR-TEST
EXTEND IA TNK
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EXTEND IA TNK
ACT
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ACT
TRACE
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TRACE
ATTEST-II
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ATTEST-II
Mechanical thrombectomy
6-24 hours
MR CLEAN
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MR CLEAN
ESCAPE
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ESCAPE
REVASCAT
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REVASCAT
SWIFT PRIME
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SWIFT PRIME
Thrombectomy in proximal LVO core volume 100ml>, within 6 hours improved functional outcomes at 90 days.
EXTEND-IA
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EXTEND-IA
Thrombectomy in proximal LVO core volume 70ml>, within 3.5hours improved 24hour neurological recovery and 90day functional outcome.
HERMES collaboration
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HERMES collaboration
DAWN
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DAWN
Thrombectomy in proximal LVO core volume 51ml>, within 6 -24 hours improved functional outcomes at 90 days.
DEFUSE-3 (6-16 hours)
Details coming soon.
DEFUSE-3
Thrombectomy in proximal LVO core volume 70ml>, within 6 -16hours improved functional outcomes at 90 days
Posterior circulation
ATTENTION
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ATTENTION
BAOCHE
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BAOCHE
Large core
ANGEL-APECTS
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ANGEL-APECTS
SELECT2
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SELECT2
Alteplase + MT (bridging)
SWIFT-DIRECT
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SWIFT-DIRECT
MR CLEAN-NO IV
Details coming soon.
MR CLEAN-NO IV
DEVT
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DEVT
SKIP
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SKIP
DIRECT-MT
Details coming soon.
DIRECT-MT
DIRECT-SAFE
Details coming soon.
DIRECT-SAFE
Lipid therapy
Atovastatin
SPARCL
Details coming soon.
SPARCL
Ezetimibe
IMPROVE-IT
Details coming soon.
IMPROVE-IT
Evolocumab (PCSK-9 inhibitors)
TA 394
Details coming soon.
TA 394
Surgery
Carotid endarterectomy
NASCET
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NASCET
ASCT
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ASCT
VIST
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VIST
ECST
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ECST
Decompressive surgery for malignant MCA
DESTINY I-III
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DESTINY I
DESTINY II
Details coming soon.
Hemicraniectomy reduces mortality among patients 60> years with large hemispheric infarction.
Hemicraniectomy increased survival without severe disability among patients > 60 years with a malignant MCA Infarction.
DECIMAL
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DECIMAL
HAMLET
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HAMLET
Carotid dissection
Antiplatelet or anticoagulation
CADISS
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CADISS
The Cervical Artery Dissection in Stroke Study found no difference in preventing stroke and death with either antiplatelet or anticoagulation therapy.
PFO closure
PFO closure
CLOSE
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CLOSE
REDUCE
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REDUCE
RESPECT
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RESPECT
CLOSURE
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CLOSURE
Antihypertensives
Antihypertensives
INDANA
Details coming soon.
INDANA
Diabetic control
Diabetic control
IRIS
Details coming soon.
IRIS
VTE
IPC
CLOTS 3
Details coming soon.
CLOTS 3
Intracerebral haemorrhage
Blood pressure control
Labetolol
INTERACT 1-3
Details coming soon.
INTERACT 1
Early intensive BP control was feasible and well tolerated and may reduce haematoma growth.
INTERACT 2
Details coming soon.
Odds of mortality were lower when SBP was <140/90 within 6hours of ICH (failed significance).
Reversing anticoagulation
TICH
Details coming soon.
TICH
ANEXA-I
Details coming soon.
ANEXA-I
FAST
Details coming soon.
FAST
NEURODEGENERATION
TOPIC
SUB-TOPIC
THERAPY
TRIAL
Alzheimer's disease
Anti-amyloid MAbs
Lecanemab
Donanemab
TRAILBLAZER-ALZ-2
Details coming soon.
TRAILBLAZER-ALZ-2
Other
Donepezil
Seltzer, 2004
Details coming soon.
Seltzer, 2004
NEUROMUSCULAR DISORDERS
TOPIC
SUB-TOPIC
THERAPY
TRIAL
ALS
Antisense oligonucleotides
Tofersen
Other
Riluzole
IL-2
MIROCALS
Details coming soon.
MIROCALS
Tauroursodeoxycholic acid
TUDCA-ALS
Details coming soon.
TUDCA-ALS
SMA
Antisense oligonucleotides
Nusinersen
CHERISH
Details coming soon.
CHERISH
MOVEMENT DISORDERS
TOPIC
SUB-TOPIC
THERAPY
TRIAL
Essential tremor
Botulinum toxin
Parkinson's
Advanced therapy
Apomorphine
TOLEDO
Details coming soon.
TOLEDO
EPILEPSY
TOPIC
SUB-TOPIC
THERAPY
TRIAL
Status epilepticus
Antiseizure medications
Levetiracetam, fosphenytoin, and sodium valproate
ECLIPSE
Levetiracetam may be a safe and effective alternative to phenytoin as a second-choice anticonvulsant in status epilepticus in children.
ECLIPSE
CONSEPT
Levetiracetam is non-superior to phenytoin as a second-choice anticonvulsant in status epilepticus in children.
CONSEPT
Focal epilepsy
Drug selection
Lamotrigine
SANAD II
Lamotrigine should remain a first-line treatment for focal epilepsy patients.
SANAD II
Temporal lobe epilepsy
Surgery
Surgery
Wiebe, 2001
Surgical management is superior to prolonged medical therapy.
Wiebe, 2001
MULTIPLE SCLEROSIS
TOPIC
SUB-TOPIC
THERAPY
TRIAL
Secondary progressive
Natalizumab
ASCEND
Natalizumab treatment did not reduce progression on the primary multicomponent disability endpoint, but it did reduce progression on the upper-limb component.
ASCEND
HEADACHE
TOPIC
SUB-TOPIC
THERAPY
TRIAL
Cluster headache
Preventative therapies
Verapamil
Lithium
Topiramate
Melatonin
Alternative therapies
Psylocybin
LSD
Migraine
To be added