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Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke

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Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. / Saver, Jeffrey L; Goyal, Mayank; Bonafe, Alain; Diener, Hans-Christoph; Levy, Elad I; Pereira, Vitor M; Albers, Gregory W; Cognard, Christophe; Cohen, David J; Hacke, Werner; Jansen, Olav; Jovin, Tudor G; Mattle, Heinrich P; Nogueira, Raul G; Siddiqui, Adnan H; Yavagal, Dileep R; Baxter, Blaise W; Devlin, Thomas G; Lopes, Demetrius K; Reddy, Vivek K; du Mesnil de Rochemont, Richard; Singer, Oliver C; Jahan, Reza; SWIFT PRIME Investigators.

In: NEW ENGL J MED, Vol. 372, No. 24, 11.06.2015, p. 2285-95.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Saver, JL, Goyal, M, Bonafe, A, Diener, H-C, Levy, EI, Pereira, VM, Albers, GW, Cognard, C, Cohen, DJ, Hacke, W, Jansen, O, Jovin, TG, Mattle, HP, Nogueira, RG, Siddiqui, AH, Yavagal, DR, Baxter, BW, Devlin, TG, Lopes, DK, Reddy, VK, du Mesnil de Rochemont, R, Singer, OC, Jahan, R & SWIFT PRIME Investigators 2015, 'Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke', NEW ENGL J MED, vol. 372, no. 24, pp. 2285-95. https://doi.org/10.1056/NEJMoa1415061

APA

Saver, J. L., Goyal, M., Bonafe, A., Diener, H-C., Levy, E. I., Pereira, V. M., Albers, G. W., Cognard, C., Cohen, D. J., Hacke, W., Jansen, O., Jovin, T. G., Mattle, H. P., Nogueira, R. G., Siddiqui, A. H., Yavagal, D. R., Baxter, B. W., Devlin, T. G., Lopes, D. K., ... SWIFT PRIME Investigators (2015). Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. NEW ENGL J MED, 372(24), 2285-95. https://doi.org/10.1056/NEJMoa1415061

Vancouver

Saver JL, Goyal M, Bonafe A, Diener H-C, Levy EI, Pereira VM et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. NEW ENGL J MED. 2015 Jun 11;372(24):2285-95. https://doi.org/10.1056/NEJMoa1415061

Bibtex

@article{e9cbf67ed6cf4d95b9faa1ac058c16c9,
title = "Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke",
abstract = "BACKGROUND: Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome.METHODS: We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group). Patients had confirmed occlusions in the proximal anterior intracranial circulation and an absence of large ischemic-core lesions. The primary outcome was the severity of global disability at 90 days, as assessed by means of the modified Rankin scale (with scores ranging from 0 [no symptoms] to 6 [death]).RESULTS: The study was stopped early because of efficacy. At 39 centers, 196 patients underwent randomization (98 patients in each group). In the intervention group, the median time from qualifying imaging to groin puncture was 57 minutes, and the rate of substantial reperfusion at the end of the procedure was 88%. Thrombectomy with the stent retriever plus intravenous t-PA reduced disability at 90 days over the entire range of scores on the modified Rankin scale (P<0.001). The rate of functional independence (modified Rankin scale score, 0 to 2) was higher in the intervention group than in the control group (60% vs. 35%, P<0.001). There were no significant between-group differences in 90-day mortality (9% vs. 12%, P=0.50) or symptomatic intracranial hemorrhage (0% vs. 3%, P=0.12).CONCLUSIONS: In patients receiving intravenous t-PA for acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, thrombectomy with a stent retriever within 6 hours after onset improved functional outcomes at 90 days. (Funded by Covidien; SWIFT PRIME ClinicalTrials.gov number, NCT01657461.).",
keywords = "Acute Disease, Administration, Intravenous, Aged, Brain Ischemia, Combined Modality Therapy, Endovascular Procedures, Female, Fibrinolytic Agents, Humans, Male, Middle Aged, Stents, Stroke, Thrombectomy, Tissue Plasminogen Activator, Treatment Outcome",
author = "Saver, {Jeffrey L} and Mayank Goyal and Alain Bonafe and Hans-Christoph Diener and Levy, {Elad I} and Pereira, {Vitor M} and Albers, {Gregory W} and Christophe Cognard and Cohen, {David J} and Werner Hacke and Olav Jansen and Jovin, {Tudor G} and Mattle, {Heinrich P} and Nogueira, {Raul G} and Siddiqui, {Adnan H} and Yavagal, {Dileep R} and Baxter, {Blaise W} and Devlin, {Thomas G} and Lopes, {Demetrius K} and Reddy, {Vivek K} and {du Mesnil de Rochemont}, Richard and Singer, {Oliver C} and Reza Jahan and {SWIFT PRIME Investigators} and G{\"o}tz Thomalla",
year = "2015",
month = jun,
day = "11",
doi = "10.1056/NEJMoa1415061",
language = "English",
volume = "372",
pages = "2285--95",
journal = "NEW ENGL J MED",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "24",

}

RIS

TY - JOUR

T1 - Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke

AU - Saver, Jeffrey L

AU - Goyal, Mayank

AU - Bonafe, Alain

AU - Diener, Hans-Christoph

AU - Levy, Elad I

AU - Pereira, Vitor M

AU - Albers, Gregory W

AU - Cognard, Christophe

AU - Cohen, David J

AU - Hacke, Werner

AU - Jansen, Olav

AU - Jovin, Tudor G

AU - Mattle, Heinrich P

AU - Nogueira, Raul G

AU - Siddiqui, Adnan H

AU - Yavagal, Dileep R

AU - Baxter, Blaise W

AU - Devlin, Thomas G

AU - Lopes, Demetrius K

AU - Reddy, Vivek K

AU - du Mesnil de Rochemont, Richard

AU - Singer, Oliver C

AU - Jahan, Reza

AU - SWIFT PRIME Investigators

AU - Thomalla, Götz

PY - 2015/6/11

Y1 - 2015/6/11

N2 - BACKGROUND: Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome.METHODS: We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group). Patients had confirmed occlusions in the proximal anterior intracranial circulation and an absence of large ischemic-core lesions. The primary outcome was the severity of global disability at 90 days, as assessed by means of the modified Rankin scale (with scores ranging from 0 [no symptoms] to 6 [death]).RESULTS: The study was stopped early because of efficacy. At 39 centers, 196 patients underwent randomization (98 patients in each group). In the intervention group, the median time from qualifying imaging to groin puncture was 57 minutes, and the rate of substantial reperfusion at the end of the procedure was 88%. Thrombectomy with the stent retriever plus intravenous t-PA reduced disability at 90 days over the entire range of scores on the modified Rankin scale (P<0.001). The rate of functional independence (modified Rankin scale score, 0 to 2) was higher in the intervention group than in the control group (60% vs. 35%, P<0.001). There were no significant between-group differences in 90-day mortality (9% vs. 12%, P=0.50) or symptomatic intracranial hemorrhage (0% vs. 3%, P=0.12).CONCLUSIONS: In patients receiving intravenous t-PA for acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, thrombectomy with a stent retriever within 6 hours after onset improved functional outcomes at 90 days. (Funded by Covidien; SWIFT PRIME ClinicalTrials.gov number, NCT01657461.).

AB - BACKGROUND: Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome.METHODS: We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group). Patients had confirmed occlusions in the proximal anterior intracranial circulation and an absence of large ischemic-core lesions. The primary outcome was the severity of global disability at 90 days, as assessed by means of the modified Rankin scale (with scores ranging from 0 [no symptoms] to 6 [death]).RESULTS: The study was stopped early because of efficacy. At 39 centers, 196 patients underwent randomization (98 patients in each group). In the intervention group, the median time from qualifying imaging to groin puncture was 57 minutes, and the rate of substantial reperfusion at the end of the procedure was 88%. Thrombectomy with the stent retriever plus intravenous t-PA reduced disability at 90 days over the entire range of scores on the modified Rankin scale (P<0.001). The rate of functional independence (modified Rankin scale score, 0 to 2) was higher in the intervention group than in the control group (60% vs. 35%, P<0.001). There were no significant between-group differences in 90-day mortality (9% vs. 12%, P=0.50) or symptomatic intracranial hemorrhage (0% vs. 3%, P=0.12).CONCLUSIONS: In patients receiving intravenous t-PA for acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, thrombectomy with a stent retriever within 6 hours after onset improved functional outcomes at 90 days. (Funded by Covidien; SWIFT PRIME ClinicalTrials.gov number, NCT01657461.).

KW - Acute Disease

KW - Administration, Intravenous

KW - Aged

KW - Brain Ischemia

KW - Combined Modality Therapy

KW - Endovascular Procedures

KW - Female

KW - Fibrinolytic Agents

KW - Humans

KW - Male

KW - Middle Aged

KW - Stents

KW - Stroke

KW - Thrombectomy

KW - Tissue Plasminogen Activator

KW - Treatment Outcome

U2 - 10.1056/NEJMoa1415061

DO - 10.1056/NEJMoa1415061

M3 - SCORING: Journal article

C2 - 25882376

VL - 372

SP - 2285

EP - 2295

JO - NEW ENGL J MED

JF - NEW ENGL J MED

SN - 0028-4793

IS - 24

ER -