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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular treatment for acute ischemic stroke
Alfonso Ciccone1, Luca Valvassori, Michele Nichelatti
1Stroke Unit and Department of Neurology, Niguarda Ca' Granda Hospital, Milan, Italy. alfonso.ciccone@aopoma.it
The New England Journal of Medicine
|February 8, 2013
Summary
Endovascular therapy for acute ischemic stroke was not superior to intravenous thrombolytic therapy. Both treatments showed similar rates of survival free of disability at 3 months.
Area of Science:
- Neurology
- Interventional Cardiology
- Emergency Medicine
Background:
- Endovascular treatment offers higher recanalization rates for ischemic stroke than intravenous thrombolysis.
- Clinical efficacy comparison between endovascular therapy and intravenous thrombolytic therapy is needed.
Purpose of the Study:
- To compare the clinical efficacy of endovascular therapy versus intravenous thrombolytic therapy in patients with acute ischemic stroke.
Main Methods:
- 362 patients with acute ischemic stroke were randomized to endovascular therapy or intravenous recombinant tissue plasminogen activator (t-PA).
- Treatments were administered as soon as possible after randomization, within 4.5 hours of stroke onset.
- The primary outcome was survival free of disability at 3 months (modified Rankin score 0-1).
Main Results:
- At 3 months, 30.4% of patients receiving endovascular therapy and 34.8% receiving intravenous t-PA were alive without disability (P=0.16).
- Median treatment times were 3.75 hours for endovascular therapy and 2.75 hours for intravenous t-PA.
- Rates of symptomatic intracranial hemorrhage within 7 days were 6% in both groups, with no significant differences in other adverse events or fatality rates.
Conclusions:
- Endovascular therapy is not superior to standard intravenous t-PA treatment for acute ischemic stroke.
- The study provides evidence that intravenous t-PA remains a standard treatment option.
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