Endovascular Intervention for Acute Ischemic Stroke

New Trials

MR CLEAN

  • Multi-center RCT in Netherlands, funded by Covidien
  • Diagnosed lesion on MRA, CTA, DSA
  • NIHSS score (11 items)
  • Primary: modified Rankin Score at 90 days - measure of ADLs
  • Euro QoL5D
  • Intervention within 4 hours
  • 82% used stent retriever
  • Limits: sick control group

ESCAPE trial

  • Canada
  • Anterior circulation
  • High functioning at baseline
  • Treatment within 12 hours
  • Excluded large infarct
  • No difference in ICH
  • 59% vs 22% functional independence
  • NNT = 4.2

EXTEND-IA

  • Reperfusion at 24 hours
  • Neuro improvement at day 3
  • 100% reperfusion vs 37% with tPA alone
  • 71% vs 40%
  • NNT = 3.2
  • Halted early (70 patients)
  • Generalizes only to 10% of stroke patients (very few people eligible for tPA)

SWIFT-PRIME trial

  • Primary: 90 day mRS
  • 196 patients
  • Confirmed findings (better reperfusion, better functional independence)
  • No difference in mortality or hemorrhage

Trials in patients who cannot have tPA

REVASCAT

  • Twice as many patients achieved functional independence

Conclusions

These studies show that intervention works.

  • Give tPA within first 4.5 hours
  • Up to 6 hours, endovascular treatment is safe and effective
  • Evidence is strongest with small infarct cores, proximal occlusions