Title

Neurothrombectomy for Acute Ischemic Stroke Across Clinical Trial Design and Technique: A Single Center Pooled Analysis

Authors

Tudor G. Jovin, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Shashvat M. Desai, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Amin Aghaebrahim, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Andrew F. Ducruet, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.Follow
Dan-Victor Giurgiutiu, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Bradley A. Gross, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Maxim Hammer, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Brian T. Jankowitz, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Mouhammad A. Jumaa, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Cynthia Kenmuir, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Guillermo Linares, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Vivek Reddy, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Marcelo Rocha, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Matthew Starr, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Viktoria Totoraitis, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Lawrence Wechsler, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Syed Zaidi, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Ashutosh P. Jadhav, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.

Document Type

Article

Abstract

The practice of endovascular therapy has evolved dramatically over the last 10 years with randomized clinical trials investigating the benefit of thrombectomy in select patient populations based on time of presentation, imaging criteria, and procedural technique. We sought to understand the benefit of thrombectomy in patients treated within the context of a clinical trial at a single academic center. Patient-level data recorded in case forms and core-lab adjudicated data were analyzed from patients enrolled in RCTs investigating the benefit of endovascular thrombectomy over medical management (IMSIII, MR RESCUE, ESCAPE, SWIFT PRIME, and DAWN) between 2007 and 2017 at a single academic referral center. A total of 134 patients (intervention group, = 81; medical group, = 53) were identified across five clinical trials (IMSIII, = 46; MR RESCUE, = 4; ESCAPE, = 24; SWIFT PRIME, = 14; DAWN, = 46). There were no significant differences between the treatment arm and control arm in terms of age, gender, baseline NIHSS, ASPECTS, and site of occlusion. Rates of good outcome were superior in the intervention group with early neurological recovery (NIHSS of 0-1 or increase NIHSS of 8 points at 24 h) at a higher rate of 49% vs. 17% ( = <0.001) and higher rates of functional independence (90 day mRS 0-2 of 53% vs. 26%, = 0.002). In multivariate logistic regression analysis, lower NIHSS and younger age were predictors of good outcome. There were comparable rates of good outcome irrespective of clinical trial, imaging selection criteria (CTP vs. MRI), early vs. late time window (0-6 h vs. 6-24 h) and procedural technique (Merci vs. Solitaire/Trevo device). There were no differences in rates of sICH, PH-2 or mortality in the intervention group vs. medical group. At a large academic center, the benefit of endovascular therapy over medical therapy is observed irrespective of clinical trial design, patient selection or procedural technique.

Keywords

clinical trial, ischemic stroke, stroke, technique, thrombectomy

Publication Date

1-1-2020

Publication Title

Frontiers in neurology

ISSN

1664-2295

Volume

11

First Page

1047

PubMed ID

33071935

Digital Object Identifier (DOI)

10.3389/fneur.2020.01047

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