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J Neurointerv Surg. 2013 Nov;5(6):506-11. doi: 10.1136/neurintsurg-2012-010541. Epub 2012 Oct 6.

Improvements in recanalization with modern stroke therapy: a review of prospective ischemic stroke trials during the last two decades.

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1
Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.

Abstract

INTRODUCTION:

A number of recent trials evaluating intra-arterial therapies for acute ischemic stroke have been completed. We present a review of prospective acute ischemic stroke trials reported in a peer-reviewed forum during the last 20 years to provide insight into the general direction of this rapidly evolving field.

METHODS:

Prospective trials evaluating acute stroke intra-arterial therapies since 1999 were included, with the National Institute of Neurological Disorders and Stroke rtPA trial published in 1995 as a baseline comparator. Patient presenting factors and outcome data were analyzed based on year of publication and best-fit lines and linear regression analyses were generated.

RESULTS:

Thirteen prospective trials were included. Regression analyses demonstrated no appreciable change in the median NIH Stroke Scale score of subjects at the time of enrollment since 1995 (p=0.44) and no appreciable improvements in good outcome based on a modified Rankin score of 0-2 at 90 days (p=0.66) or mortality at 90 days (p=0.55). A significant increase in time from onset of symptoms to treatment among enrolled patients was noted from 1995 to 2012 (p=0.03). In addition, a significant improvement in recanalization/reperfusion was noted over the last two decades (p=0.02).

CONCLUSIONS:

This review of prospective acute ischemic stroke trials since 1999 indicates a substantial improvement in revascularization in the setting of a significant increase in time to therapy onset, but no appreciable change in good functional outcome.

KEYWORDS:

Intervention; Stroke; Thrombectomy; Thrombolysis

PMID:
23042748
DOI:
10.1136/neurintsurg-2012-010541
[Indexed for MEDLINE]
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