February 8, 2013

Endovascular Treatment Not Superior to Intravenous TPA for Acute Stroke

A study published in the New England Journal of Medicine (6 Feb 2013) did not find different outcomes of acute stroke patients treated with endovascular therapy vs intravenous TPA


  • IV recombinant tissue plasminogen activator (t-PA) is the standard treatment for acute ischemic stroke
  • Endovascular (intraarterial) treatment has higher recanalization rates but whether this translates into more favorable clinical outcome is unknown
  • Prior trials of endovascular treatment showed promising results but there were problems with 1) limited generalizability, 2) lack of comparison between endovascular Rx and IV t-PA, 3) endovascular Rx was not assessed as a multimodality procedure

Study Methods and Results

  • Multicenter, open-treatment clinical trial with a blinded end point
  • Questions: whether outcomes were better with endovascular Rx than with IV t-PA
  • Included patients are between 18-80 years, with a clearly defined time of stroke onset that was less than 4.5 hours (for IV t-PA) or 6 hours (for endovascular Rx)
  • 362 patients with acute ischemic stroke were randomized to either endovascular Rx (IA thrombolysis with rt-PA, mechanical clot disruption or retrieval, or a combination of these) or to IV rt-PA
  • Primary outcome = disability-free survival at 90 days, secondary outcome = proportion of patients with mild neurologic deficit or none and several safety measures
  • Disability-free survival at 90 days = 30% in endovascular group, 35% in IV group. This did not change after adjustment for age, sex, stroke severity or presence of atrial fibrillation

Ciccone A et al. Endovascular treatment for acute ischemic stroke. N Eng J Med 2013 Feb 6.
Read the full study HERE

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