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Endovascular Treatment for Acute Ischemic Stroke
Endovascular Treatment for Acute Ischemic Stroke
- Publication Year :
- 2013
-
Abstract
- In patients with ischemic stroke, endovascular treatment results in a higher rate of recanalization of the affected cerebral artery than systemic intravenous thrombolytic therapy. However, comparison of the clinical efficacy of the two approaches is needed.We randomly assigned 362 patients with acute ischemic stroke, within 4.5 hours after onset, to endovascular therapy (intraarterial thrombolysis with recombinant tissue plasminogen activator [t-PA], mechanical clot disruption or retrieval, or a combination of these approaches) or intravenous t-PA. Treatments were to be given as soon as possible after randomization. The primary outcome was survival free of disability (defined as a modified Rankin score of 0 or 1 on a scale of 0 to 6, with 0 indicating no symptoms, 1 no clinically significant disability despite symptoms, and 6 death) at 3 months.A total of 181 patients were assigned to receive endovascular therapy, and 181 intravenous t-PA. The median time from stroke onset to the start of treatment was 3.75 hours for endovascular therapy and 2.75 hours for intravenous t-PA (P0.001). At 3 months, 55 patients in the endovascular-therapy group (30.4%) and 63 in the intravenous t-PA group (34.8%) were alive without disability (odds ratio adjusted for age, sex, stroke severity, and atrial fibrillation status at baseline, 0.71; 95% confidence interval, 0.44 to 1.14; P=0.16). Fatal or nonfatal symptomatic intracranial hemorrhage within 7 days occurred in 6% of the patients in each group, and there were no significant differences between groups in the rates of other serious adverse events or the case fatality rate.The results of this trial in patients with acute ischemic stroke indicate that endovascular therapy is not superior to standard treatment with intravenous t-PA. (Funded by the Italian Medicines Agency, ClinicalTrials.gov number, NCT00640367.).
- Subjects :
- Adult
Male
OCCLUSION
Psychoanalysis
RECANALIZATION
Neuroimaging
Article
law.invention
Brain Ischemia
TISSUE-PLASMINOGEN-ACTIVATOR
Randomized controlled trial
Fibrinolytic Agents
law
Case fatality rate
medicine
Humans
Single-Blind Method
PROUROKINASE
cardiovascular diseases
Adverse effect
Infusions, Intravenous
Stroke
Aged
Cerebral Hemorrhage
Thrombectomy
business.industry
Standard treatment
Endovascular Procedures
TISSUE-PLASMINOGEN-ACTIVATOR, CEREBRAL-ARTERY STROKE, RANDOMIZED-TRIAL, INTRAARTERIAL THROMBOLYSIS, INTRAVENOUS THROMBOLYSIS, OCCLUSION, REVASCULARIZATION, RECANALIZATION, PROUROKINASE, THROMBECTOMY
Atrial fibrillation
General Medicine
Odds ratio
Middle Aged
medicine.disease
INTRAARTERIAL THROMBOLYSIS
Combined Modality Therapy
RANDOMIZED-TRIAL
Cerebral Angiography
Treatment Outcome
Anesthesia
Tissue Plasminogen Activator
Acute Disease
REVASCULARIZATION
Female
INTRAVENOUS THROMBOLYSIS
CEREBRAL-ARTERY STROKE
business
Fibrinolytic agent
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....8016446b2228ae8c16ad52b7bb4eab08