ASA: Endovascular Therapy Beneficial for Large Ischemic Strokes

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Two studies were stopped early due to efficacy of endovascular therapy compared with medical care alone

By Elana Gotkine HealthDay Reporter

WEDNESDAY, Feb. 15, 2023 (HealthDay News) — For patients with large ischemic strokes, endovascular therapy is associated with improved outcomes, according to two studies published online Feb. 10 in the New England Journal of Medicine to coincide the annual American Stroke Association International Stroke Conference, held from Feb. 8 to 10 in Dallas.

Xiaochuan Huo, M.D., Ph.D., from Beijing Tiantan Hospital, and colleagues conducted a prospective open-label randomized trial involving patients with acute large-vessel occlusion in the anterior circulation. Participants were randomly assigned within 24 hours to undergo endovascular therapy and receive medical management or receive medical management alone (231 and 225, respectively). Due to the efficacy of endovascular therapy, the trial was stopped early after the second interim analysis. The researchers found a shift in the distribution of scores on the modified Rankin scale toward better outcomes in favor of endovascular therapy at 90 days (generalized odds ratio, 1.37).

Amrou Sarraj, M.D., from the University Hospitals Cleveland Medical Center-Case Western Reserve University, and colleagues conducted an open-label, randomized trial involving patients with stroke due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery, with large ischemic core volume. Patients were randomly assigned to endovascular thrombectomy plus medical care or medical care alone within 24 hours after onset (178 and 174 patients, respectively). The trial was stopped early for efficacy. The researchers observed a shift in the distribution of modified Rankin scale scores toward better outcomes in favor of thrombectomy (generalized odds ratio, 1.51).

“Together, the trials provide reassuring information from more than a thousand patients with large ischemic strokes in different medical systems that will probably lead to changes in patterns of care delivery,” writes the author of an accompanying editorial.

Several authors from the Huo study disclosed financial ties to the biopharmaceutical and medical device industries, including companies that provided study funding. Several authors from the Sarraj study disclosed ties to biopharmaceutical and medical device companies, including Stryker, which funded the study.

Abstract/Full Text – Huo (subscription or payment may be required)

Abstract/Full Text – Sarraj (subscription or payment may be required)

Editorial (subscription or payment may be required)

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