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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe EXTEND-IA trial compared endovascular therapy with the Solitaire FR flow restoration stent retriever after intravenous tissue plasminogen activator versus tissue plasminogen activator alone for ischemic stroke. Mechanical thrombectomy was beneficial in patients with large vessel occlusion and salvageable ischemic tissue.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEXTEND-IA\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etissue plasminogen activator\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eendovascular therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emechanical stent thrombectomy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eischemic stroke\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESolitaire FR flow restoration device\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etissue reperfusion\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneurological recovery\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EBruce C.V. Campbell, MD, Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Melbourne, Australia, presented data from the investigator-initiated EXTEND-IA study [Campbell BCV et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015], demonstrating the benefit of endovascular therapy in patients with large vessel occlusion stroke.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAccording to Dr Campbell, who presented the EXTEND-IA results on behalf of co-principal investigator Dr Peter Mitchell and co-chairs Dr Stephen Davis and Dr Geoffrey Donnan, previous trials comparing endovascular therapy and intravenous tissue plasminogen activator (tPA) for patients with ischemic stroke produced conflicting results. With this in mind, EXTEND-IA was a multicenter trial conducted in Australia and New Zealand to determine whether the use of advanced imaging, superior devices, and earlier intervention could improve patient outcomes. The study compared the effect of endovascular therapy after intravenous tPA vs tPA alone for ischemic stroke, using computed tomography (CT) perfusion imaging selection. It aimed to select patients with proven major vessel occlusion and salvageable ischemic tissue (irreversibly injured ischemic core volume\u2009\u0026lt;\u200970 ml) who were most likely to respond favorably to reperfusion.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EEligibility criteria included the ability to receive tPA within 4.5 hours of the onset of anterior circulation ischemic stroke, and occlusion of the internal carotid artery or of the middle cerebral artery that was accessible to stent thrombectomy. Participants were randomized to receive tPA alone or tPA plus endovascular stent thrombectomy with the Solitaire FR flow restoration device.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe primary end points were the proportion of ischemic tissue that had undergone reperfusion at 24 hours on CT or magnetic resonance perfusion imaging, and early neurologic recovery (defined as a reduction of 8 or more points on the National Institutes of Health Stroke Scale, or reaching a score of 0 or 1 by day 3). A key secondary outcome was analysis of modified Rankin Scale (mRS) at 90 days.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThe trial was stopped early, with 70 of the planned 100 participants enrolled, after analysis prompted by the release of positive results in the MR CLEAN study [Berkhemer OA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015]. The Data Safety Monitoring Committee terminated the trial when this early analysis showed significant efficacy on the co-primary outcome. Reperfusion of the ischemic tissue was increased in the intervention group compared with the control group (100% vs 37%; \u003Cem\u003EP\u003C\/em\u003E\u2009\u0026lt;\u2009.0001), as was early neurologic improvement (80% vs 37%; \u003Cem\u003EP\u003C\/em\u003E\u2009=\u2009.002). In addition, independent functional outcome (mRS 0 to 2) at 90 days was 71% in the intervention group, compared with 40% in the control group (\u003Cem\u003EP\u003C\/em\u003E\u2009\u0026lt;\u2009.01). No safety concerns were identified during the study, with no significant differences in the incidence of adverse events between the groups, said Dr Campbell.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe results of this trial showed that, in a group of patients with large vessel occlusion screened and selected for having salvageable tissue, early mechanical stent thrombectomy after tPA treatment resulted in faster and more complete tissue reperfusion. This led to improved early neurologic recovery and enhanced functional outcome at 3 months.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EDr Campbell noted that the early termination of this trial did pose limitations. It created the potential for overestimation of the effect size, and the small sample size also precluded subgroup analysis. Nevertheless, he stressed that the data were statistically robust and unequivocal in demonstrating that tPA combined with early stent thrombectomy improve patient outcomes. In the context of the 4 positive randomized trials now reported, stent thrombectomy should be the new standard of care for patients with large vessel occlusion stroke.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/2\/8.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlqk4\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}