ASA: Endovascular Therapy After t-PA No Benefit in Stroke
(HealthDay News) – For patients with acute ischemic stroke, the addition of endovascular therapy is not superior to intravenous tissue plasminogen activator (t-PA) alone; and neuroimaging does not identify patients who would benefit from endovascular therapy, according to two studies published online Feb. 8 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.
Joseph P. Broderick, MD, from the University of Cincinnati Neuroscience Institute, and colleagues randomly allocated eligible patients with acute ischemic stroke who had received t-PA within three hours after symptom onset to receive addition of endovascular therapy or intravenous t-PA alone in a 2:1 ratio. After 656 patients had been randomized, the study was stopped prematurely due to futility. The researchers observed no significant difference in the proportion of patients with a modified Rankin score of ≤2 at 90 days (40.8% with addition of endovascular therapy vs. 38.7% with intravenous t-PA alone).
Chelsea S. Kidwell, MD, from Georgetown University in Washington, D.C., and colleagues conducted a randomized study to examine whether brain imaging (pretreatment computed tomography or magnetic resonance imaging) could identify which patients with large-vessel, anterior-circulation strokes would benefit from endovascular thrombectomy vs. standard care. The researchers found that, among the 118 eligible patients, there was no difference across the groups in the 90-day mortality rate or the rate of symptomatic intracranial hemorrhage. The mean scores on the modified Rankin scale were no different for embolectomy or standard care.
"A favorable penumbral pattern on neuroimaging did not identify patients who would differentially benefit from endovascular therapy for acute ischemic stroke, nor was embolectomy shown to be superior to standard care," Kidwell and colleagues write.
Several authors from the Broderick study disclosed financial ties to the pharmaceutical and biotechnology industries, including companies that provided grants for the study. Concentric Medical provided catheters and devices used in the Kidwell study from initiation until August 2007.