ASA: Endovascular Therapy No More Effective Than t-PA in Stroke
(HealthDay News) – For patients with acute ischemic stroke, endovascular therapy is not superior to standard treatment with intravenous tissue plasminogen activator (t-PA), according to a study published online Feb. 6 in the New England Journal of Medicine to coincide with presentation at the American Heart Association's International Stroke Conference, held from Feb. 5–8 in Honolulu.
Alfonso Ciccone, MD, from Niguarda Ca'Granda Hospital in Milan, and colleagues compared endovascular treatment with systemic intravenous thrombolytic therapy in a cohort of 362 patients with acute ischemic stroke. Participants were randomized in a 1:1 ratio to endovascular therapy (intraarterial thrombolysis with recombinant t-PA, mechanical clot disruption or retrieval, or a combination) or to intravenous t-PA within 4.5 hours after stroke onset.
The researcher found that, at three months, 30.4% of patients in the endovascular-therapy group and 34.8% in the intravenous t-PA group were alive without disability (age-, sex-, stroke severity-, and atrial fibrillation status at baseline-adjusted odds ratio, 0.71; P=0.16). 6% of patients in each group experienced fatal or nonfatal symptomatic intracranial hemorrhage within seven days. The rates of other serious adverse events and the case fatality rate were not significantly different between the groups.
"This trial did not show that endovascular therapy achieves superior outcomes as compared with intravenous thrombolysis, and our findings do not provide support for the use of the more invasive and expensive endovascular therapy over intravenous treatment," the authors write.
Boehringer Ingelheim provided t-PA for use in the trial.