Study Supports Endovascular Stroke Treatments in Community-Based Hospital Stroke Centers

October 15, 2013—Matthew H. Berlet, MD, et al published findings from a 2-year, retrospective, nonrandomized study comparing endovascular therapies in acute ischemic stroke patients with the goal of developing a new comprehensive acute stroke algorithm. The investigators sought to determine if modern ischemic stroke therapy in a large, community-based dedicated stroke center improves clinical outcomes. The study is available online ahead of print in the Journal of Stroke & Cerebrovascular Diseases.

The single-center study was conducted at St. Joseph's Hospital in Tampa, Florida. The 76 patients in the study were placed into five different treatment groups for acute ischemic stroke. These groups included: group 1 (no treatment; n = 24), group 2 (intravenous [IV] tissue plasminogen activator [tPA] only; n = 18), group 3 (intra-arterial [IA] tPA; n = 9), group 4 (Mechanical Embolus Removal in Cerebral Ischemia [MERCI retrieval only; n = 17), and group 5 (combined IA/MERCI; n = 8).

Age range for all groups was 29 to 92 years. There were 39 women (51.3%) and 37 men (48.7%). The mean age for all patients was 70.1 years.

The pre- and post–National Institutes of Health Stroke Scale (NIHSS) values were obtained for each group on arrival and discharge from the hospital. The results of the four treatment cohorts were compared with the no treatment group, providing the relative efficacy of these procedures compared with conservative medical therapy alone.

As summarized in the Journal of Stroke & Cerebrovascular Diseases, Group 1 (without treatment) demonstrated a 2.2 NIHSS reduction (11.1 at admission vs 8.9 at discharge). Group 2 (IV tPA) had a 7.1 NIHSS reduction (11.8 at admission vs 4.7 at discharge). Group 3 (IA tPA) had a 8.7 NIHSS reduction (16.1 at admission vs 7.4 at discharge). Group 4 (MERCI) had a 12.8 NIHSS reduction (15.9 at admission vs 3.1 at discharge). Group 5 (combined IA tPA/MERCI) had a 5.1 NIHSS reduction (15.7 at admission vs 10.6 at discharge). MERCI procedures were conducted using the Merci Retriever system (Stryker Corporation, Kalamazoo, MI). Stryker acquired the Merci device's developer, Concentric Medical, Inc. (Mountain View, CA), in 2011.

Four patients expired during their admission, two from group 1 (control group) and two from group 5 (combined IA/MERCI group). The results showed a statistically significant difference for the five groups at the P < .05 level in change in NIHSS scores.

Modern endovascular therapies for acute ischemic stroke do improve clinical outcomes when implemented in the setting of a dedicated comprehensive stroke team, concluded the investigators in Journal of Stroke & Cerebrovascular Disease.