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.

PY - 2013/9

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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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