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Updated: Jul 5, 2026
06:01
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Intra-arterial therapies for acute ischemic stroke
Pitchaiah Mandava1, Thomas A Kent
1Michael E. DeBakey VA Medical Center Stroke Program and Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
Neurology
|June 15, 2007
Summary
Intra-arterial therapy for acute ischemic stroke shows variable outcomes with no clear benefit over predicted natural history. Further trials are needed to compare it with best medical treatment.
Area of Science:
- Neurology
- Interventional Radiology
Background:
- No randomized trials compare intra-arterial (IA) therapy with best medical treatment for acute ischemic stroke.
- Systematic review of published IA series performed to assess potential benefit.
- Outcomes compared against prognostic models adjusted for NIHSS scores and age.
Purpose of the Study:
- To systematically review published intra-arterial therapy series for acute ischemic stroke.
- To assess the potential benefit of IA therapy compared to predicted natural history.
- To identify factors associated with better outcomes in IA therapy for stroke.
Main Methods:
- Systematic review of 27 reports (30 series, 1,117 patients) with 3-month follow-up.
- Outcome functions from prognostic models generated; difference from prediction calculated.
- Best and worst mortality performers identified and assessed for distinguishing factors.
Main Results:
- Percent difference from predicted mortality: -51% to +24.6%; good functional outcome: -30.3% to +28.7%.
- Mean difference in mortality: +0.25%; good functional outcome: -0.15%.
- Better mortality performers had higher NIHSS scores and used lower urokinase doses.
Conclusions:
- Considerable variability in outcomes; lack of evidence for net improvement with IA therapy.
- Need for prospective comparison with best medical therapy is substantiated.
- Features of better performers may inform future trial design.
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