22 May Comparison of Final Infarct Volumes in Patients Who Received Endovascular Therapy or Intravenous Thrombolysis for Acute Intracranial Large-Vessel Occlusions
Dr. Rishi Gupta, MD
Associate Professor of Neurology, Neurosurgery and Radiology
Emory University School of Medicine
Director, Vascular Neurology Fellowship Program
Director, Multi-Hospital Acute Stroke Network
Marcus Stroke and Neuroscience Center
Grady Memorial Hospital
MedicalResearch.com: What are the main findings of the study?
Dr. Gupta: The main findings of this study are that patients with more proximal cerebral arterial occlusion involving the middle cerebral artery and internal carotid artery appear to be the targets for endovascular reperfusion therapy trials. Moreover, previous clinical trials have used a NIHSS > 8 or > 10 threshold to include patients into randomzed trials comparing endovascular therapy versus IV tPA. The threshold may need to be higher and in our analysis we found that threshold to be 14 or greater.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Gupta: We were surprised by the NIHSS threshold being higher than what is used in clinical trials, but the concept makes sense. Those patients with more areas of potential neurological injury appear to be the ones most apt to benefit from reperfusion and endovascular reperfusion is the able to achieve this a higher percentage of the time compared to IV tPA or medical management.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Gupta: Clinicians should take away that there is much we need to learn about endovascular therapy and that studies such as ours will help shape future clinical trials in the hopes of showing efficacy of endovascular reperfusion therapy in the future.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Gupta: Our hope is that trialists will use our results and integrate some of the principles in trial design.
Rangaraju S, Owada K, Noorian A, et al. Comparison of Final Infarct Volumes in Patients Who Received Endovascular Therapy or Intravenous Thrombolysis for Acute Intracranial Large-Vessel Occlusions. JAMA Neurol. 2013;():1-6. doi:10.1001/jamaneurol.2013.413.