Analysis Supports Endovascular Therapy After tPA Within 3 Hours of Symptom Onset of Severe Ischemic Stroke

December 15, 2015—Online in Stroke, Joseph P. Broderick, MD, et al, published findings from an assessment of the effect of endovascular treatment in acute ischemic stroke patients with severe neurologic deficit after a prespecified analysis plan.

The pooled analysis of the Interventional Management of Stroke III (IMS III) and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trials included participants with a National Institutes of Health Stroke Scale score of ≥ 20 before intravenous tissue-type plasminogen activator (tPA) treatment (IMS III) or randomization (MR CLEAN) who were treated with intravenous tPA ≤ 3 hours of stroke onset.

As summarized in Stroke, the investigators hypothesized that participants with severe stroke randomized to endovascular therapy after intravenous tPA would have an improved 90-day outcome (distribution of modified Rankin Scale [mRS] scores) when compared with those who received intravenous tPA alone.

The investigators reported that among 342 participants in the pooled analysis (194 from IMS III and 148 from MR CLEAN), an ordinal logistic regression model showed that the endovascular group had superior 90-day outcome compared with the intravenous tPA group (adjusted odds ratio, 1.78; 95% confidence interval, 1.2–2.66).

In the logistic regression model of the dichotomous outcome (mRS score, 0–2, or functional independence), the endovascular group had superior outcomes (adjusted odds ratio, 1.97; 95% confidence interval, 1.09–3.56). Functional independence (mRS score ≤ 2) at 90 days was 25% in the endovascular group as compared with 14% in the intravenous tPA group.

Endovascular therapy after intravenous tPA within 3 hours of symptom onset improves functional outcome at 90 days after severe ischemic stroke, concluded the investigators in Stroke.