Endovascular therapy yields significantly superior outcomes for large vessel occlusions compared with intravenous thrombolysis: is it time to randomize

Details

• Personal Author:
  Carpenter JS ; Hobbs GR ; Raghuram K ; Rai AT ; Roberts TD ; Rodgers D
• Description:
  Background and purpose: We compared outcomes between endovascular (EV) therapy and intravenous (IV) thrombolysis in large vessel strokes. Methods: 223 patients who had received either IV (n=100) or EV (n=123) therapy were analyzed. Only patients with strokes involving the internal carotid artery terminus (ICA-T, n=45), the middle cerebral artery (M1, n=107) or the bifurcation branches (M2, n=71) were included. The primary endpoint was 3 month outcome based on the modified Rankin Scale (mRS) score, good outcome defined as mRS ?2. Results: The good outcome was 44.7% in the EV group and 26% in the IV group (p=0.003, OR 2.3, 95% CI 1.3 to 4.1). There was no difference in mortality or hemorrhage. For ICA-T occlusions, the good outcome was 27.6% in the EV and 0% in the IV group (p=0.004); for M1 occlusions, 40.6% in the EV versus 10.5% in the IV group (p=0.0006, OR 5.8, 95% CI 1.9 to 18.2); and for M2 occlusions, 76% in the EV versus 47.8% in the IV group (p=0.01, OR 3.5, 95% CI 1.2 to 10.2). For M1 occlusions, the death rate was 27.5% for the EV compared with 57.9% for the IV group (p=0.002, OR 3.6, 95% CI 1.6 to 8.3) with no difference observed in mortality for ICA-T or M2 occlusions. In the univariate analysis, age, National Institutes of Health Stroke Scale score and occlusion site were significant predictors of outcome and mortality (p<0.0001 for all). In the multivariable analysis, EV therapy (p=0.0004, OR 3.9, 95% CI 1.8 to 9) and younger age (p<0.0001, OR 0.96, 95% CI 0.9 to 0.98) were significant independent predictors of good outcome. Conclusions: There are significantly higher odds of a favorable outcome with EV compared with IV therapy for large vessel strokes. The data support the rationale of a randomized trial for large vessel occlusions. [Description provided by NIOSH]
• Subjects:
  Blood Men Morbidity Mortality Occupational Health Safety Women
• Keywords:
  Blood Vessels Health Care Humans Ischemic Stroke Morbidity Rates Mortality Rates Treatment
• ISSN:
  1759-8478
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  OSHA Region 3 ; OSHA Region 5 ; West Virginia ; Wisconsin
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  430-434
• Volume:
  5
• Issue:
  5
• NIOSHTIC Number:
  nn:20049369
• Citation:
  J Neurointervent Surg 2013 Sep; 5(5):430-434
• Contact Point Address:
  Dr. A.T. Rai, Interventional Neuroradiology, West Virginia University Hospital, One Medical Center Drive, Morgantown, WV 26508
• Email:
  ansaar.rai@gmail.com
• Federal Fiscal Year:
  2013
• Performing Organization:
  West Virginia University
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of Neurointerventional Surgery
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d1defb06b0da771d5457c9c669258d6b71c80a63f73846c9bcf0b4bfe712c2a0122c12cecd3272ceb56c1d55299e6293c0c89e73b5150f4cec0f5966daa4291f
• Download URL:
  https://stacks.cdc.gov/view/cdc/203833/cdc_203833_DS1.pdf
• File Type:
  [PDF - 175.70 KB ]