BNA 2023 | The challenge of removing established treatments: EVT + IVT

Johanna Ospel, MD, PhD, University of Basel, Basel, Switzerland, shares her thoughts on the ongoing debate predominating discussions in the acute ischemic stroke field: does intravenous thrombolysis (IVT) add benefit beyond what can be achieved with endovascular thrombectomy (EVT) alone. Data from numerous rigorous trials addressing this question were combined in the IRIS collaboration meta-analysis, in the hopes of providing a clear-cut answer on the value of IVT for patients arriving directly at EVT-capable centers. While the between-group difference was minimal, the study was unable to prove that EVT alone was non-inferior to EVT with prior IVT. As such, IVT plus EVT remains the standard of care and the scientific debate continues. Dr Ospel comments on the wider issue exemplified by this controversy, whereby removing established treatments is more difficult than adding new options, given the high threshold of certainty required. This interview took place at The BNA 2023 International Festival of Neuroscience in Brighton, UK.

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