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