The DIRECT-MT trial, a multicenter prospective RCT, was published on New England Journal of Medicine (IF=70.67) on 2020-05-07. The chairman was prof. Jianmin LIU, the director of Neurosurgery of Changhai hospital affiliated to Naval Medical University. A total of 41 hospitals contributed to this study.

DIRECT-MT showed that the functional outcome of AIS patients received endovascular thrombectomy without intravenous alteplase was comparable with those with intravenous alteplase within 4.5 hours since onset. The result provided us a clue that intravenous alteplase might be skipped in certain patients.

Sub-group analysis and post-hoc analysis would be completed in few months and would provide more high-level evidence for the endovascular treatment of AIS patients, which means that patients could receive individualized treatment according to clinical status and the conditions of each institution. For instance, patients with large vessel occlusion in comprehensive stroke center which is capable of rapid endovascular treatment, direct mechanical thrombectomy without intravenous alteplase might be reasonable and more efficient. With more evidence published, the endovascular treatment would be more standardized and rational.

In the press conference on May 7, 2020, the MR CLEANinvestigators (Prof. Majoie and Prof. Roos) expressed their congratulations via video. Prof. Longde WANG, academician of China and the deputy director of the Stroke Prevention engineering Committee of the National Health Commission, also sent best wishes and congratulations via video. Prof. Jianmin LIU made a live interpretation of the study. The video is available online:http://www.medtion.com/meetingInfoLive.jspx?id=1258

ESO and WSO as two of the most influential stroke prevention organizations in the world, have long been committed to improve management, education and research on stroke by coordinating national/regional development. DIRECT-MT was the first original work by Chinese panel neurointerventionalists that was published on the New England Journal of Medicine and was ESO-WSO 2020 selected as the TOP 5 in 2020 international stroke study on ESO-WSO 2020. During webinar of ESO-WSO,2020, prof. Jianmin Liu presented the result of DIRECT-MT to world peer and caused hot discussion among neurointerventionalists all over the world.

A celebration dinner party for DIRCET-MT PIs was held during 2020 OCIN conference on Oct. 23. All the participating centers took photo to memory the publication of the article and the release of the research results. Director Jianmin Liu delivered a speech to express his deep expectation on the future study of China and high requirement on following Enchanted 2, willingness of cooperation as well.

Official announcement: The "Ten Major events" in stroke prevention and treatment in 2020 are worthy of attention, DIRECT-MT trial was selected，announced by National Health Commission of the People’s Republic of China.

[1] P. Yang, L. Zhang, Y. Zhang, Z. Li, P. Xiang, B. Hong, Y.B.W.E.M. Roos, C.B.L.M. Majoie, B. Deng, J. Liu (DIRECT MT Investigators). Direct Intra-arterial Thrombectomy in Order to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals (DIRECT-MT). European Stroke Journal, vol. 3, 1_suppl: pp. 3-204.