Statement of ESMINT and ESNR regarding recent trials evaluating the endovascular treatment at the acute stage of ischemic stroke

Piérot, Laurent; Söderman, Michael; Bendszus, Martin; White, Phil; Muto, Massimo; Turjman, Francis; Mangiafico, Salvatore; Gralla, Jan; Fiehler, Jens; Szikora, I; Cognard, Christophe

doi:10.1007/s00234-013-1249-3

Cited by 22 publications

(16 citation statements)

References 29 publications

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“…Different NIHSS subgroups were analyzed in the trials (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and ≥20 in MR CLEAN, 6-19 and >19 in ESCAPE, and ≤17 and >17 in SWIFT PRIME). In all trials, OR favored mechanical thrombectomy, irrespective of the NIHSS group.…”

Section: Nihss and Aspectsmentioning

confidence: 99%

“…[9][10][11] The path was clear after these trials, however. 12,13 First, in Interventional Management of Stroke III (IMS III), no imaging screen for large vessel occlusion was used in nearly half of the enrolled patients, leading to the inclusion of many patients who were not candidates for intervention. 14 The more recent trials have benefited from wide availability of computed tomographic angiography (CTA).…”

Section: Introductionmentioning

confidence: 99%

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Interventionalist Perspective on the New Endovascular Trials

Pierot,

Derdeyn

2015

Stroke

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Abstract-Three recently published trials have conclusively proven the benefit of mechanical endovascular thrombectomy over best medical therapy for patients with acute ischemic stroke and large vessel occlusion. These trials shared some features and differed in others. These similarities and differences in trial design and execution affect the conclusions and recommendations that can be made from the data. We will examine the implications of these studies for neurointerventionists, both for current practice and for future studies. In particular, we will focus on procedural details such as patient selection, devices, adjunctive therapies, treatment time windows, and performance metrics. (Stroke.

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Section: Nihss and Aspectsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Interventionalist Perspective on the New Endovascular Trials

Pierot,

Derdeyn

2015

Stroke

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“…Yilmaz et al efit of endovascular therapy compared with intra-venous (IV)-thrombolysis alone [5][6][7]. Though the validity of these latter studies regarding state-of-the-art endovascular treatment is in dispute, they have initiated a discussion about the importance of patient-selection for endovascular treatment in acute stroke [8,9]. Still few criteria for patient-selection have been established [10].…”

Section: Methodsmentioning

confidence: 99%

Carotid Elongation Does Not Affect Angiographic Results of Mechanical Thrombectomy in Acute Stroke

et al. 2014

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“…9,10 More recent trials using second-generation endovascular devices have demonstrated higher rates of recanalization and reperfusion (80%-95%). 19,20 We explored hypothetical scenarios to understand the interplay of time to reperfusion and rates of reperfusion because they are potentially modifiable factors for future endovascular trials.…”

Section: Downloaded Frommentioning

confidence: 99%

“…7,8 Another reason for the negative trials could be use of first-generation devices with lower recanalization rates than more recent devices. 9,10 As we consider treatment paradigms and design trials for acute stroke therapies, the trade-off between risks and benefits, especially as related to time to treatment and reperfusion rate need to be carefully considered. We developed a decision analytic model that addresses these issues.…”

mentioning

confidence: 99%

Time to Angiographic Reperfusion in Acute Ischemic Stroke

Vagal

Khatri

Broderick³

et al. 2014

Stroke

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We used a standard computer program (Decision Maker, Boston, MA) to build the decision analytic model, analyze results, and Background and Purpose-Our objective was to use decision analytic modeling to compare 2 treatment strategies of intravenous recombinant tissue-type plasminogen activator (r-tPA) alone versus combined intravenous r-tPA/endovascular therapy in a subgroup of patients with large vessel (internal carotid artery terminus, M1, and M2) occlusion based on varying times to angiographic reperfusion and varying rates of reperfusion. Methods-We developed a decision model using Interventional Management of Stroke (IMS) III trial data and comprehensive literature review. We performed 1-way sensitivity analyses for time to reperfusion and 2-way sensitivity for time to reperfusion and rate of reperfusion success. We also performed probabilistic sensitivity analyses to address uncertainty in total time to reperfusion for the endovascular approach. Results-In the base case, endovascular approach yielded a higher expected utility (6.38 quality-adjusted life years) than the intravenous-only arm (5.42 quality-adjusted life years). One-way sensitivity analyses demonstrated superiority of endovascular treatment to intravenous-only arm unless time to reperfusion exceeded 347 minutes. Two-way sensitivity analysis demonstrated that endovascular treatment was preferred when probability of reperfusion is high and time to reperfusion is small. Probabilistic sensitivity results demonstrated an average gain for endovascular therapy of 0.76 quality-adjusted life years (SD 0.82) compared with the intravenous-only approach. Conclusions-In our post hoc model with its underlying limitations, endovascular therapy after intravenous r-tPA is the preferred treatment as compared with intravenous r-tPA alone. However, if time to reperfusion exceeds 347 minutes, intravenous r-tPA alone is the recommended strategy. This warrants validation in a randomized, prospective trial among patients with large vessel occlusions. (Stroke. 2014;45:3625-3630.)

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Statement of ESMINT and ESNR regarding recent trials evaluating the endovascular treatment at the acute stage of ischemic stroke

Cited by 22 publications

References 29 publications

Interventionalist Perspective on the New Endovascular Trials

Interventionalist Perspective on the New Endovascular Trials

Carotid Elongation Does Not Affect Angiographic Results of Mechanical Thrombectomy in Acute Stroke

Time to Angiographic Reperfusion in Acute Ischemic Stroke

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