Johannes Kaesmacher (Switzerland)
University Hospital – Inselspital – Bern University Institute of Diagnostic and Interventional NeuroradiologyAuthor Of 2 Presentations
DIRECT MECHANICAL THROMBECTOMY VERSUS BRIDGING THERAPY FOR ACUTE ISCHAEMIC STROKE–A CUMULATIVE STUDY-LEVEL META-ANALYSIS OF THE DIRECT-MT, MRCLEAN-NOIV, DEVT, SKIP AND SWIFT-DIRECT RCTS: PLACEHOLDER ABSTRACT
Abstract
Background and Aims
Whether direct mechanical thrombectomy (MT) in acute ischaemic stroke patients with large vessel occlusion (LVO) is equally effective as intravenous thrombolysis (IVT) with alteplase followed by MT remains a matter of debate. Primary aim of this study was to test non-inferiority of direct mechanical thrombectomy using summary estimates of study-level aggregate data of all randomized controlled trials evaluating direct MT vs IVT followed by MT. Secondary aims included superiority testing of IVT followed by MT versus direct MT and presentation of relevant secondary outcomes.
Methods
We performed a PROSPERO registered, prespecified, systematic review of electronic databases (Web of Science, PubMed, Embase) and meta-analysis with data presentation adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random effects models were used to pool the study-level data. The primary outcome used for non-inferiority and superiority testing was good functional outcome at 90 days (mRS≤2). The non-inferiority margin was prespecified. Secondary outcomes included excellent functional outcome (mRS≤1), mortality, symptomatic intracranial haemorrhage (sICH), successful reperfusion (TICI≥2b) and procedure-related complications. Five RCTs comprising 2043 patients (xy dMT, yx bridging therapy) were included.
Results
To be determined.
Conclusions
To be determined.
SOLITAIRE™ WITH THE INTENTION FOR THROMBECTOMY PLUS INTRAVENOUS T-PA VERSUS DIRECT SOLITAIRE™ STENT-RETRIEVER THROMBECTOMY IN ACUTE ANTERIOR CIRCULATION STROKE (SWIFT DIRECT)
Abstract
Background and Aims
Whether treatment with intravenous alteplase prior to mechanical thrombectomy (MT) in acute ischaemic stroke (AIS) patients with large vessel occlusion is beneficial remains a matter of debate. We aimed to determine whether patients experiencing AIS due to occlusion of the intracranial internal carotid artery or the M1 segment of the middle cerebral artery who are referred to an endovascular stroke centre and who are candidates for intravenous alteplase will have non-inferior functional outcome at 90 days when treated with MT alone (direct MT) with stent retrievers compared to patients treated with combined intravenous thrombolysis (IVT) with alteplase plus MT (IVT+MT) with stent retrievers.
Methods
We conducted prospective, randomized (1:1), open-label, blinded-endpoint (PROBE) trial at 44 academic tertiary care centers in Europe and North America, utilizing an adaptive statistical design. Primary efficacy, defined as functional independence (mRS 0-2) at 90 days, was assessed for non-inferiority of the experimental arm to the standard arm using a one-sided type 1-error rate of 5% with a pre-specified non-inferiority margin of 12%. Secondary objectives were to study causes of mortality, dependency and quality of life.
Results
A total of 410 patients were randomly assigned either to the direct MT group (xy patients) or to the intravenous alteplase plus MT group (xy patients). Direct MT was …..
Conclusions
Among patients with ischaemic stroke due to proximal anterior vessel occlusion within 4.5 hours from onset, direct mechanical thrombectomy compared with intravenous alteplase plus mechanical thrombectomy was…..