Thrombectomy within 8 Hours of Ischemic Stroke Reduces Disability Severity

VBCN - July 2015 Volume 2, No 2

Preventing disability after stroke remains a challenge. A recent multicenter randomized phase 3 clinical trial investigated the efficacy and safety of neurovascular thrombectomy in patients with acute ischemic stroke who received treatment within 8 hours of symptom onset. The results showed that consistent with the results of other recent trials of early treatment of stroke, the use of stent retriever thrombectomy within 8 hours of symptom onset reduced the patient’s poststroke disability severity and increased poststroke functional independence (Jovin TG, et al. N Engl J Med. 2015;372:2296-2306).

Tudor G. Jovin, MD, Associate Professor of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA, and colleagues conducted a prospective, open-label trial of 206 patients who were eligible for treatment within 8 hours of the onset of their acute ischemic stroke symptoms. Patients were randomly assigned to receive medical therapy with the Solitaire stent retriever (ie, the thrombectomy group) in addition to endovascular therapy, or to medical therapy alone (ie, the control group).

The baseline characteristics of patients in both groups were similar, and the mean ages of the patients in the thrombectomy and control groups were 65.7 years and 67.2 years, respectively. The primary end point, which was measured per the modified Rankin scale, was the severity of global disability at 90 days.

A primary outcome analysis demonstrated a thrombectomy-favoring improvement in the distribution of the modified Rankin scale score, with an odds ratio (OR) of 1.7 (95% confidence interval [CI], 1.05-2.8). The secondary outcome measures included successful revascularization, which was achieved in 66% of patients in the thrombectomy group based on core laboratory assessments, and in 80% of the patients based on the assessments of local interventionalists.

At 90 days, no significant differences occurred in death rates between the thrombectomy and the control groups (18.4% vs 15.5%, respectively; P = .60) or in symptomatic intracranial hemorrhage (1.9% in each group; P = 1.00). Furthermore, the patients in the thrombectomy group experienced higher rates of functional independence at 90 days (43.7% vs 28.2%, respectively; adjusted OR, 2.1; 95% CI, 1.1-4.0).

Thus, this study adds to the evidence that supports the efficacy of neurovas­cular thrombectomy in this patient population.

“Our study findings are consistent with those of recently reported trials, showing that in patients with acute stroke caused by a proximal large-vessel occlusion and an absence of a large infarct on baseline imaging, mechanical thrombectomy with the Solitaire stent retriever was safe and led to improved clinical outcomes as compared with medical therapy alone,” the investigators concluded.

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