tPA an Unnecessary Adjunct to Endovascular Thrombectomy? An Analysis of the DIRECT-MT Trial

Spiegel, Rory; Radecki, Ryan P.

doi:10.1016/j.annemergmed.2020.06.028

Cited by 1 publication

(2 citation statements)

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“…The inferior outcome measures of the current study were consistent with a meta-analysis [ 7 ] but not consistent with those of randomized trials [ 2 , 11 ]. The large sample size (type-II error) of a randomized trial [ 2 ] (disease-oriented evidence requires smaller sample sizes for analyses [ 25 ]) and unbalanced randomization of a trial [ 11 ] are responsible for contradictory results. The outcomes of endovascular thrombectomy with or without intravenous alteplase are different in Chinese patients with acute ischemic stroke than those of white patients [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Also, the prehospital triage method is more complicated in mainland China than the Western countries. The reperfusion rate is disease-related proof [ 25 ]. Improvements in reperfusion (64% survivors from the EA cohort and 61% survivors from the ET cohort were reported partial or complete recanalization (the modified Arterial Occlusive Lesion score ≥ 1) at 3 days after endovascular thrombectomy) was reported but these did not translate into clinical benefits (patients of both cohorts reported moderate clinical outcomes; only 38% survivors from the EA cohort and 39% from survivors from the ET cohort had the modified Rankin scale score between 0 and 2 at 90 days after endovascular thrombectomy).…”

Section: Discussionmentioning

confidence: 99%

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Endovascular Thrombectomy preceded by intravenous Alteplase versus endovascular Thrombectomy alone in Han Chinese patients treated for acute ischemic stroke with large vessel occlusion: a single-center retrospective analysis

Han

Yue

et al. 2021

BMC Neurol

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Background The American Heart Association/ American Stroke Association and the Chinese Stroke Association guidelines are recommending intravenous alteplase intervention before endovascular thrombectomy if patients are eligible to do so but the benefits of endovascular thrombectomy are different in Chinese patients with stroke than those of the white patients. The objective of the study was to compare outcomes of patients with acute ischemic stroke treated with endovascular thrombectomy with intravenous alteplase against those treated with endovascular thrombectomy alone. Methods A report is a retrospective analysis of comparing demographics, imaging, clinical and adverse outcomes in the Han Chinese patient who underwent mechanical thrombectomy for acute ischemic stroke with large vessel occlusion, with or without preceding intravenous alteplase administration. Patients with terminus and non-terminus intracranial occlusions and ≤ 2 points neurologic deficit underwent endovascular thrombectomy preceded by 0.9 mg/ kg intravenous alteplase (ET cohort, n = 184) and those who had contra-indication for intravenous alteplase were treated with endovascular thrombectomy alone (EA cohort, n = 141). Results The most common procedural complications were embolization into new territory (p = 0.866) and uneventful artery vasospasm (p = 0.712). Insignificant differences were reported for any procedural complications (p = 0.991), imaging outcomes, the modified Rankin scale score (p = 0.663), and death (28 vs. 24, p = 0.761) within 90 days between patients of both cohorts. At the discharge of the hospital, the National Institutes of Health Stroke Scale scores of patients of the ET cohort were lower than those of the EA cohort (8.58 ± 3.79 vs. 10.23 ± 4.97, p = 0.003). The Barthel Index of survivors at 90 days after endovascular thrombectomy was higher for patients of the ET cohort than those of the EA cohort (87.47 ± 12.58 vs. 84.01 ± 13.47, p = 0.032). The most common adverse effect was asymptomatic intracranial hemorrhage (p = 0.297). Insignificant differences were reported for adverse effects after thrombectomy between survivors of both cohorts. Conclusions Outcome measures in Han Chinese patients with acute ischemic stroke treated with endovascular thrombectomy alone were statistically the same as those treated with endovascular thrombectomy plus intravenous alteplase. Level of evidence Iii Technical efficacy stage 4.

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