Work

Randomization of endovascular treatment with stent-retriever and/or thromboaspiration versus best medical therapy in acute ischemic stroke due to large vessel occlusion in the extended time window trial (RESILIENT-Extend): Rationale and design

Year: 2026

Type: article

Abstract: BACKGROUND: Randomized trials have demonstrated substantial benefit of mechanical thrombectomy (MT) in selected patients treated 6-24 h after stroke onset. However, these trials relied on advanced imaging not typically available in resource-constrained settings. The RESILIENT-Extend trial aims to evaluate the efficacy and safety of MT in the 8- to 24-h window using a pragmatic imaging selection based on non-contrast computed tomography (CT) and CT angiography alone. METHODS: RESILIENT-Extend is a multicenter, randomized, controlled, open-label, blinded-endpoint, phase 3 trial conducted in Brazil. The planned sample size is 376 participants. Patients presenting with anterior-circulation large vessel occlusion within 8-24 h from time last known well will be randomized 1:1 to receive either MT plus best medical management (BMM) or BMM alone. The trial uses a minimization algorithm to balance prognostic variables including age, National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS), occlusion site, time window, and clinical site. The primary outcome is the distribution of 90-day modified Rankin Scale scores assessed by blinded central adjudication. DISCUSSION: RESILIENT-Extend is one of the first randomized trials to evaluate MT in the extended window using a pragmatic selection strategy based exclusively on widely available imaging modalities (non-contrast CT and CT angiography), with a focus on scalability in real-world and resource-constrained settings. TRIAL REGISTRATION: clinicaltrials.govNCT04256096.

Source: International Journal of Stroke

DOI: 10.1177/17474930261472689