Endovascular therapy yields significantly superior outcomes for large vessel occlusions compared with intravenous thrombolysis

Is it time to randomize?

Ansaar T. Rai, Jeffrey S. Carpenter, Karthikram Raghuram, Thomas D. Roberts, Daniel Rodgers, Gerald R. Hobbs

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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, goodoutcome 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.

Original languageEnglish (US)
Pages (from-to)430-434
Number of pages5
JournalJournal of NeuroInterventional Surgery
Volume5
Issue number5
DOIs
StatePublished - Sep 2013
Externally publishedYes

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Stroke
Mortality
Middle Cerebral Artery
National Institutes of Health (U.S.)
Internal Carotid Artery
Therapeutics
Hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Endovascular therapy yields significantly superior outcomes for large vessel occlusions compared with intravenous thrombolysis : Is it time to randomize? / Rai, Ansaar T.; Carpenter, Jeffrey S.; Raghuram, Karthikram; Roberts, Thomas D.; Rodgers, Daniel; Hobbs, Gerald R.

In: Journal of NeuroInterventional Surgery, Vol. 5, No. 5, 09.2013, p. 430-434.

Research output: Contribution to journalArticle

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title = "Endovascular therapy yields significantly superior outcomes for large vessel occlusions compared with intravenous thrombolysis: Is it time to randomize?",
abstract = "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, goodoutcome 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.",
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T1 - Endovascular therapy yields significantly superior outcomes for large vessel occlusions compared with intravenous thrombolysis

T2 - Is it time to randomize?

AU - Rai, Ansaar T.

AU - Carpenter, Jeffrey S.

AU - Raghuram, Karthikram

AU - Roberts, Thomas D.

AU - Rodgers, Daniel

AU - Hobbs, Gerald R.

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N2 - 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, goodoutcome 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.

AB - 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, goodoutcome 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.

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