Thrombectomy May Be Best in Stroke Patients With Mismatch
Benefit for patients well six to 24 hours earlier with mismatch in clinical deficit severity, infarct volume
MONDAY, Nov. 13, 2017 (HealthDay News) -- For patients with acute stroke who were last well six to 24 hours earlier and who had a mismatch between the severity of the clinical deficit and the infarct volume, thrombectomy plus standard care is associated with better outcomes than standard care alone, according to a study published online Nov. 11 in the New England Journal of Medicine to coincide with the annual meeting of the Society of Vascular and Interventional Neurology, held Nov. 8 to 11 in Boston.
Raul G. Nogueira, M.D., from Emory University School of Medicine in Atlanta, and colleagues enrolled patients with intracranial internal carotid artery or proximal middle cerebral artery occlusion who had last been known to be well six to 24 hours earlier and had a mismatch between the severity of the clinical deficit and the infarct volume. Participants were randomized to thrombectomy plus standard care (107 patients) or standard care alone (control group; 99 patients); enrollment in the trial was stopped at 31 months because of the results of the prespecified interim analysis.
The researchers found that the mean score on the utility-weighted modified Rankin scale was 5.5 and 3.4 in the thrombectomy and control groups, respectively, at 90 days (adjusted difference, 2 points; 95 percent credible interval, 1.1 to 3 points); the rate of functional independence was 49 and 13 percent, respectively, at 90 days (adjusted difference, 33 percentage points; 95 percent credible interval, 24 to 44 percentage points). The team found that rates of symptomatic intracranial hemorrhage did not differ significantly between the two groups.
"Outcomes for disability at 90 days were better with thrombectomy plus standard care than with standard care alone," the authors write.
Several authors disclosed financial ties to pharmaceutical and medical device companies, including Stryker Neurovascular, which funded the study.