Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial

Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

“…3,9,10 Key lessons learned from these previous trials are the need for proof of proximal vessel occlusion, 11 rapid and effective imaging methods to exclude patients with a large infarct core, 12-14 an efficient workflow to achieve fast recanalization, 15,16 and high reperfusion rates. [17][18][19] Recent studies have shown the superiority of retrievable stents over the previous generation of thrombectomy devices. 17,18 The recently reported Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) used this technology, and the results of that trial showed clinical benefit with endovascular treatment.…”

Statement of ESMINT and ESNR regarding recent trials evaluating the endovascular treatment at the acute stage of ischemic stroke

“…The clinical impact of the use of these novel devices has been impressively illustrated by the recent Solitaire™ with the intention for thrombectomy (SWIFT) trial which directly compared mechanical thrombectomy with MERCI (first generation) and Solitaire™ (second generation) devices in a randomized trial. In a global population of 113 patients (MERCI=53, Solitaire™=58), successful recanalization without symptomatic intracranial hemorrhage (primary endpoint) was achieved in 61 % of patients in the Solitaire™ group and 24 % or patients in the MERCI group (p <0.0001) [27]. Outcomes were significantly better for patients treated with the Solitaire™ device.…”

“…(3) An important limitation of the IMS III study is that the modalities of endovascular treatment were very heterogeneous and some became obsolete during the course of the trial: 164/434 patients (37.8 %) were treated by IA rTPA administration through a standard or EKOS microcatheter, 149/434 (34.3 %) by mechanical thrombectomy with first-generation devices (MERCI or Penumbra), and only 5/434 (1.2 %) by mechanical thrombectomy with a second-generation device, such as the Solitaire™ FR device. As the SWIFT and TREVO2 trial have clearly demonstrated, the secondgeneration devices are more efficacious than firstgeneration devices in terms of both recanalization and clinical outcome (see below) [27,28]. (4) Finally, time from stroke onset to initiation of IV rTPA (mean) was 121 min in the IV rTPA group alone and 122 min in the endovascular therapy group.…”

Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke

“…This choice was driven by the findings of SWIFT and TREVO-2, two head-to-head randomized clinical trials comparing the reperfusion performance of stent retrievers against the MERCI device, where stent retrievers yielded a four-times higher chance of post-procedure reperfusion and higher rates of good clinical outcome 32,33 . Indeed, prior trials that did not show benefit of endovascular treatment used other first generation mechanical thrombectomy devices (mainly the MERCI device) or intra-arterial injection of TPA 21,22,34 .…”