Accuracy of the New ICD-9-CM Code for “Drip-and-Ship” Thrombolytic Treatment in Patients With Ischemic Stroke

Tonarelli, Silvina B.; Tibbs, Michael; Vázquez, Gabriela; Lakshminarayan, Kamakshi; Rodríguez, Gustavo J.; Qureshi, Adnan I.

doi:10.1016/j.jstrokecerebrovasdis.2010.05.011

Cited by 8 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The primary disadvantage of endovascular therapy is the delay in initiation of treatment because of the time required to mobilize the interventional team and, in many cases, the need to transfer the patient to another hospital. 7,8 Other potential limitations include difficulty getting the catheter to the site of occlusion, damage to the arterial wall from devices, fragmentation and distal embolization of the thrombus, risks associated with general anesthesia (if used), and complications of systemic and cerebral hemorrhage. 7,9,10 In the absence of data from a randomized trial, it is uncertain whether endovascular therapy, with or without the previous use of intravenous t-PA, is more effective than intravenous t-PA alone.…”

mentioning

confidence: 99%

Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke

Palesch²,

et al. 2013

View full text Add to dashboard Cite

BACKGROUND Endovascular therapy is increasingly used after the administration of intravenous tissue plasminogen activator (t-PA) for patients with moderate-to-severe acute ischemic stroke, but whether a combined approach is more effective than intravenous t-PA alone is uncertain. METHODS We randomly assigned eligible patients who had received intravenous t-PA within 3 hours after symptom onset to receive additional endovascular therapy or intravenous t-PA alone, in a 2:1 ratio. The primary outcome measure was a modified Rankin scale score of 2 or less (indicating functional independence) at 90 days (scores range from 0 to 6, with higher scores indicating greater disability). RESULTS The study was stopped early because of futility after 656 participants had undergone randomization (434 patients to endovascular therapy and 222 to intravenous t-PA alone). The proportion of participants with a modified Rankin score of 2 or less at 90 days did not differ significantly according to treatment (40.8% with endovascular therapy and 38.7% with intravenous t-PA; absolute adjusted difference, 1.5 percentage points; 95% confidence interval [CI], −6.1 to 9.1, with adjustment for the National Institutes of Health Stroke Scale [NIHSS] score [8–19, indicating moderately severe stroke, or ≥20, indicating severe stroke]), nor were there significant differences for the predefined subgroups of patients with an NIHSS score of 20 or higher (6.8 percentage points; 95% CI, −4.4 to 18.1) and those with a score of 19 or lower (−1.0 percentage point; 95% CI, −10.8 to 8.8). Findings in the endovascular-therapy and intravenous t-PA groups were similar for mortality at 90 days (19.1% and 21.6%, respectively; P = 0.52) and the proportion of patients with symptomatic intracerebral hemorrhage within 30 hours after initiation of t-PA (6.2% and 5.9%, respectively; P = 0.83). CONCLUSIONS The trial showed similar safety outcomes and no significant difference in functional independence with endovascular therapy after intravenous t-PA, as compared with intravenous t-PA alone. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00359424.)

show abstract

mentioning

confidence: 99%

Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke

Palesch²,

et al. 2013

View full text Add to dashboard Cite

show abstract

“…One of the main benefits of this approach is its rapid, simplistic, and high recanalization rate [11]. On the other hand, the main drawback of endovascular therapy is the duration of time before initiation of treatment is increased [12, 13]. Furthermore, it needs specialized intervention teams and centers, due to the difficulty in getting the catheter to the site of occlusion.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, it needs specialized intervention teams and centers, due to the difficulty in getting the catheter to the site of occlusion. In addition, other limitations to this approach include arterial wall damage, fragmentation, and embolization of the thrombus [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment plus Medical Treatment versus Medical Treatment Alone in Ischemic Stroke: A Systematic Review and Meta-Analysis

Toubasi,

Al-Sayegh,

Albustanji

et al. 2023

Eur Neurol

View full text Add to dashboard Cite

Introduction This study was conducted to assess the hypothesis that endovascular treatment in addition to medical treatment improve stroke mortality and post-stroke disability. Methods In this systematic review and meta-analysis, the studies were included if they were randomized controlled trials in design and compared between endovascular treatment and medical therapy vs medical therapy alone in stroke management. Results The search yielded 22 articles that included 5,049 patients. The analysis showed significant association between the intervention and reduction in disability measured by Modified Rankin Scale (mRS) (mRS=0-2) (OR=1.61; 95%CI:1.27-2.06) and National Institute of Health Stroke Scale (NIHSS) (NIHSS=0-15) (OR=2.13; 95%CI: 1.04-4.34). Also, we found a significant difference in disability scores between the intervention and the medical therapy group (mRS WMD=-0.59; 95%CI: -1.15- -0.02, NIHSS WMD= -4.52; 95%CI: -6.32- -2.72). Additionally, there was significant reduction in mortality in the intervention group (OR=0.79; 95%CI: 0.68-0.92). There was no significant difference in the rate of any serious adverse effects between the two study groups except for asymptomatic intracerebral hemorrhage. Conclusion Our study provides strong evidence stemmed from randomized clinical trials that endovascular treatment combined with medical therapy is superior to medical therapy alone in the management of stroke.

show abstract

“…24,25 Endovascular therapy has been used to treat patients with occlusions of large intracranial arteries, given the perceived advantage of this modality leading to more frequent and rapid recanalization of occlusions when compared to IV rt-PA. 24,26 A disadvantage of endovascular therapy is the delay in initiation of treatment due to the time required to mobilize an interventional team, as well as the need to transfer patients to centers with the required expertise. [26][27][28] Furthermore, risk of complications such as reperfusion injury, liberation of thrombus for distal embolization, and vessel injury is higher than complications with IV rt-PA.…”

Section: Introductionmentioning

confidence: 99%

What is the Role for Intra-Arterial Therapy in Acute Stroke Intervention?

O’Carroll

Rubin

Chong

2015

The Neurohospitalist

View full text Add to dashboard Cite

Intravenous recombinant tissue plasminogen activator continues to be first-line therapy for patients with acute ischemic stroke presenting within the appropriate time window, but one potential limitation is the low rate of recanalization in the setting of large artery occlusions. Intra-arterial (IA) treatment is effective for emergency revascularization of proximal intracranial arterial occlusions, but proof of benefit has been lacking until recently. Our goal is to outline the history of endovascular therapy and review both IA thrombolysis and mechanical interventions. In addition, we will discuss the impact of important trials such as the Third Interventional Management of Stroke (IMS3) trial, and the more recent trials Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE), Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) on acute stroke management and the implications for the practicing neurohospitalist.

show abstract

Accuracy of the New ICD-9-CM Code for “Drip-and-Ship” Thrombolytic Treatment in Patients With Ischemic Stroke

Cited by 8 publications

References 7 publications

Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke

Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke

Endovascular Treatment plus Medical Treatment versus Medical Treatment Alone in Ischemic Stroke: A Systematic Review and Meta-Analysis

What is the Role for Intra-Arterial Therapy in Acute Stroke Intervention?

Contact Info

Product

Resources

About