Thursday, July 02, 2015

MR Clean results


A PROBE, two-arm, superiority trial that studied 500 patients with acute ischemic stroke caused by an proximal intracranial occlusion in the anterior circulation [distal intracranial carotid artery, middle cerebral artery (M1 or M2), or anterior cerebral artery (A1 or A2)] established by computed tomographic angiography (CTA), magnetic resonance angiography (MRA), or digital-subtraction angiography (DSA), and a score of 2 or higher on the NIHSS

Initiation of endovascular treatment within 6 hours of stroke onset had to be possible.

Patients who were eligible in agreement with national guidelines received IV rtPA. Those with a non-favorable response were eligible for inclusion.
 
Results:

Randomized 1:1 (usual care, IA treatment plus usual care)

Occlusion site: M1 (64%), ICA + M1 (27%)

Onset to groin puncture: 260 (210-313 IQR) minutes

Stent retriever used in: 81.5%

TICI 2b/3 revascularization in 59%; Stroke to reperfusion time: 322 (279-394 IQR) minutes

The treatment effect was estimated as an odds ratio, adjusted for pre-specified prognostic factors, that IA treatment would lead to lower mRS at 90 days, as compared with usual care alone (shift analysis)

Outcome:Absolute difference of 13.5% (95% CI, 1.21 to 2.30) in achieving mRS 0-2 in favor of the intervention group

This difference became non-significant if reperfusion was delayed > 6.2 hours
 
COMMENT- MAY SUPPORT NOT INTERVENING AFTER SIX HOURS
 
ONSET TO GROIN PUNCTURE 4.3 HOURS
ONSET TO REPERFUSION 5.3 HOURS

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