Article Text

other Versions

PDF
Review
Improvements in recanalization with modern stroke therapy: a review of prospective ischemic stroke trials during the last two decades
  1. Kyle M Fargen1,
  2. Philip M Meyers2,
  3. Pooja Khatri3,
  4. J Mocco4
  1. 1Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
  2. 2Department of Neurological Surgery, Columbia University, New York, New York, USA
  3. 3Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
  4. 4Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA
  1. Correspondence to Dr Kyle M Fargen, Department of Neurosurgery, University of Florida, Box 100265, Gainesville, FL 32610, USA; Kyle.fargen{at}neurosurgery.ufl.edu

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.

  • Intervention
  • Stroke
  • Thrombectomy
  • Thrombolysis

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.