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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular Therapy for Acute Stroke with a Large Ischemic Region
Shinichi Yoshimura1, Nobuyuki Sakai1, Hiroshi Yamagami1
1From the Departments of Neurosurgery (S.Y., K.U., M.B., F.S., N. Kinjo) and Clinical Epidemiology (K.U., F.S., N. Kinjo, T.S., T.M.), Hyogo College of Medicine, Nishinomiya, the Departments of Neurosurgery (N.S., H.I.) and Diagnostic Radiology (R.I.), Kobe City Medical Center General Hospital, Kobe, the Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka (H.Y.), the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita (K.T., M.I.), the Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki (Y. Matsumaru), the Department of Neuroendovascular Therapy (Y. Matsumoto) and the Department of Stroke Neurology (Y.Y., T.S.), Kohnan Hospital, Sendai, the Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo (K.K.), the Department of Neurosurgery, Seisho Hospital, Odawara (M.T.), the Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka (N. Kimura), the Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa (K.S.), the Department of Neuroendovascular Therapy, Hachinohe City Hospital, Hachinohe (I.S.), the Department of Neurosurgery, Gifu University Hospital, Gifu (Y.E.), the Department of Neuroendovascular Therapy, National Hospital Organization Kyusyu Medical Center, Fukuoka (S.T.), and the Department of Cerebrovascular Medicine, Niigata City General Hospital, Niigata (K.M.) - all in Japan.
Endovascular therapy significantly improved functional outcomes for large acute ischemic strokes compared to medical care alone. However, this approach also increased the risk of intracranial hemorrhage in stroke patients.
Area of Science:
- Neurology
- Interventional Radiology
- Public Health
Background:
- Large cerebral infarctions are typically treated with medical care alone, as endovascular therapy is often avoided.
- The comparative effectiveness of endovascular therapy versus medical care alone for large strokes remains understudied.
Purpose of the Study:
- To evaluate the efficacy and safety of endovascular therapy combined with medical care compared to medical care alone in patients with large acute ischemic strokes.
Main Methods:
- A multicenter, randomized clinical trial in Japan involving 203 patients with large cerebral vessel occlusion and sizable strokes (Alberta Stroke Program Early Computed Tomographic Score [ASPECTS] 3-5).
- Patients were randomized 1:1 to receive endovascular therapy plus medical care or medical care alone within 6-24 hours of last known well.
- The primary outcome was a modified Rankin scale score of 0-3 at 90 days.
Main Results:
- 31.0% of patients receiving endovascular therapy achieved a modified Rankin scale score of 0-3 at 90 days, versus 12.7% in the medical care group (relative risk, 2.43; P=0.002).
- Endovascular therapy also showed a greater improvement in National Institutes of Health Stroke Scale (NIHSS) scores at 48 hours (31.0% vs 8.8%).
- Intracranial hemorrhage occurred in 58.0% of the endovascular therapy group compared to 31.4% in the medical care group.
Conclusions:
- Endovascular therapy with medical care resulted in better functional outcomes for patients with large acute ischemic strokes compared to medical care alone.
- The study highlights an increased risk of intracranial hemorrhage associated with endovascular therapy in this patient population.
