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Article History

Received: 1 March 2025

Revised: 3 November 2025

Accepted: 17 November 2025

First Online: 14 January 2026

Compliance with ethical standards

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: The scientific guarantor of this publication is Sven P.R. Luijten (Erasmus MC University Medical Center).

: A.G. reports research support from the Canadian Institutes of Health Research, Canadian Cardiovascular Society, Alberta Innovates, Campus Alberta Neuroscience, Government of Canada—INOVAIT Program, Government of Canada—New Frontiers in Research Fund, Microvention, Alzheimer Society of Canada, Heart and Stroke Foundation of Canada, and Panmure House; consultancy for MD Analytics, MyMedicalPanel, CTC Communications, Atheneum, DeepBench, Research on Mind, Creative Research Designs, and AlphaSights; honoraria from Alexion and Biogen; editorial board involvement for Neurology: Clinical Practice, Neurology, Stroke, and Frontiers in Neurology; and stock options with SnapDx, TheRounds, and Collavidence. A.P.M. reports supported by the UKRI CDT in AI for Healthcare (grant no. P/S023283/1). P.B. reports support by UK National Institute for Health Research i4i Program (II-LA-0814-20007); and is a cofounder of Gripable Ltd, an Imperial College London spin-out company. S.B. reports personal fees from the University of Calgary during the conduct of the HERMES collaboration and membership on a data safety monitoring board (DSMB) for the TESLA trial, no payment was accepted. K.W.M. reports a grant from Boehringer Ingelheim paid to his institution for support of the ATTEST-2 trial; consulting fees from Boehringer Ingelheim, AbbVie, and Biogen; and BHF-funded DSMB participation (ARREST trial). J.S. reports compensation from Medtronic USA, Inc., for consultant services; compensation from BrainsGate for consultant services; compensation from Biogen for consultant services; compensation from MIVI Neuroscience for data and safety monitoring services; and stock options in Rapid Medical. A.M.D. reports honoraria from Medtronic, grants from Cerenovus for the ENDOLOW trial, and participated in a DSMB for the WE-TRUST trial (Philips). T.G.J. reports honoraria from Stryker, Silk Road Medical, Blockade Medical, FreeOx Biomedical, Route 92, Neurotrauma Science, Viz.ai, Corindus, Anaconda, Medtronic, Contego, and Methinks as a consultant; and has consulted for Cerenovus as a steering committee member and Stryker Neurovascular as a principal investigator of DAWN and AURORA. PMW reports unrestricted grants from Stryker, Medtronic (Covidien), and Penumbra paid to the institution. MDH reports a research grant from Medtronic paid to the University of Calgary for the HERMES collaboration; grants all paid to the University of Calgary from Boehringer-Ingelheim (for the TEMPO-2 trial), Biogen, NoNO (for the ESCAPE-NA1 trial, ESCAPE-NEXT trial), Canadian Institutes for Health Research (for the ESCAPE-NA1 trial, ESCAPE-NEXT trial), and Alberta Innovates (for the QuICR Alberta Stroke Program; some of the funds were used for the ESCAPE-NA1 trial). M.D.H. also reports paid work for Sun Pharma and Brainsgate for adjudication of clinical trial outcomes; patents (US Patent 62/086,077 and US Patent 10,916,346) licensed to Circle NVI; and participation as a DSMB chair for the RACECAT trial (end 2020), DUMAS trial (end 2022), Oncovir Hiltonel trial (ongoing), and DSMB member for the ARTESIA trial (ongoing) and BRAIN-AF trial (ongoing). M.D.H. is president of the Canadian Neurological Sciences Federation (not for profit), board member of the Canadian Stroke Consortium (not for profit), and holds stock in Circle and PureWeb. PJM reports speaking engagements from Stryker and Medtronic, and research institutional support from Stryker Neurovascular and Medtronic. C.B.L.M.M. reports grants from the Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation, TWIN Foundation, European Commission, Healthcare Evaluation Netherlands, and Stryker (all paid to his institution); and is a (minority interest) shareholder of Nicolab. MG reports that Medtronic, NoNO, and Cerenovus provided a grant to the University of Calgary; royalties or licenses from GE Healthcare for systems of acute stroke diagnosis and Microventric for systems of intracranial access; consulting fees from Medtronic, Microvention, Stryker, and Mentice; and holds stock in Circle Neurovascular. Diederik Dippel and Aad van der Lugt report funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Medtronic, Thrombolytic Science, LLC, and Cerenovus for research, all paid to the institution. Aad van der Lugt additionally reports grants from Siemens Medical Solutions USA, Inc., Philips, and GE Healthcare.

: Two of the authors have significant statistical expertise: Sven P.R. Luijten and Scott Brown.

: Written informed consent was provided by all patients according to each trial protocol.

: Each study included in the current meta-analysis was approved by the local ethics board.

: The HERMES collaboration .

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