Results from 6 recent randomized trials of mechanical thrombectomy using predominantly stent retriever devices (MR CLEAN, SWIFT PRIME, EXTEND-IA, ESCAPE, REVASCAT, THRACE) support COR I, LOE A recommendations for a defined group of patients as described in the 2015 Guidelines.105 110 A pooled, patient-level analysis from 5 of these studies reported by the HERMES Collaboration showed treatment effect in the subgroup of 188 patients not treated with IV alteplase (cOR, 2.43 [95% CI, 1.30 4.55]); therefore, pretreatment with IV alteplase has been removed from the prior recommendation. The HERMES pooled patient-level data also showed that mechanical thrombectomy had a favorable effect over standard care in patients 80 years of age (cOR, 3.68 [95% CI, 1.95 6.92]).189 In patient-level data pooled from trials in which the Solitaire was the only or the predominant device used, a prespecified meta-analysis (SEER Collaboration [Safety and Efficacy of Solitaire Stent Thrombectomy Individual Patient Data Meta-Analysis of Randomized Trials]: SWIFT PRIME, ESCAPE, EXTEND-IA, REVASCAT) showed that mechanical thrombectomy had a favorable effect over standard care in patients 80 years of age (3.46 [95% CI, 1.58 7.60]).190 In a meta-analysis of 5 RCTs (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT), there was favorable effect with mechanical thrombectomy over standard care without heterogeneity of effect across patient age subgroups (for patients <70 and However, the number of patients in these trials who were 90 years of age was very small, and the benefit of mechanical thrombectomy over standard care in patients 90 years of age is not clear. As with any treatment decision in an elderly patient, consideration of comorbidities and risks should factor into the decision-making for mechanical thrombectomy. See Tables XVII and XLV in online Data Supplement 1. 3.7.1. 