From the Journals

Thrombectomy shines in presence of a clinical deficit and imaging mismatch


 

FROM NEW ENGLAND JOURNAL OF MEDICINE

Thrombectomy plus standard care was superior to standard care alone in patients who had experienced an acute ischemic stroke 6-24 hours earlier and who had a mismatch between clinical deficit and infarct, according to Raul G. Nogueira, MD, and his DAWN trial coinvestigators.

A total of 206 patients who had experienced occlusion of the intracranial internal carotid artery or proximal middle cerebral artery in the past 6-24 hours were included in the study – 107 receiving thrombectomy with the Trevo device plus standard care and 99 receiving standard care alone. After 90 days of treatment, the mean utility-weighted modified Rankin scale score for patients who received thrombectomy was 5.5, compared with 3.4 in the control group. The rate of functional independence was 49% in the thrombectomy group and 13% in the control group.

Dr. Raul G. Nogueira
Dr. Raul G. Nogueira
Performance in all secondary trial endpoints (early response, recanalization at 24 hours, change from baseline in infarct volume at 24 hours, infarct volume at 24 hours, and grade of 2b or 3 on the modified Thrombolysis in Cerebral Infarction scale) was superior in the thrombectomy group. There was no difference in the number of serious adverse events between trial groups, and the thrombectomy group experienced a 14% rate of neurologic deterioration, compared with 26% in the control group.

“Further studies are needed to establish the prevalence of patients who would be eligible for thrombectomy among the entire population of patients with ischemic stroke. Further studies are also needed to determine whether late thrombectomy has a benefit when more widely available imaging techniques are used to estimate the infarct volume at presentation, such as assessment of the extent of hypodensity on non–contrast-enhanced CT,” the investigators noted.

SOURCE: Nogueira R et al. N Engl J Med. 2018;378:11-21

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