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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\u003EA pooled analysis of MR CLEAN and IMS III trial data from the patient subgroup with National Institutes of Health Stroke Scale score\u2009\u2265\u200920 demonstrated the benefit of endovascular therapy in addition to intravenous tissue plasminogen activator treatment in patients presenting with severe stroke.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eendovascular\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EIMS III\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMR CLEAN\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epooled analysis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Estroke\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etissue plasminogen activator\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EJoseph P. Broderick, MD, University of Cincinnati, Cincinnati, Ohio, USA, reported results of a pooled analysis of patients with a National Institutes of Health Stroke Scale (NIHSS) score\u2009\u2265\u200920 in the MR CLEAN trial [Berkhemer OA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015] and IMS III trial [Broderick JP et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2013]. The pooled analysis of the 2 trials examined the efficacy of endovascular therapy in addition to intravenous tissue plasminogen activator (IV tPA) vs IV tPA alone and demonstrated that endovascular therapy after IV tPA improved outcomes in patients presenting with severe stroke.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EMR CLEAN was the first study to demonstrate efficacy of intra-arterial treatment received within 6 hours of stroke onset in patients with acute ischemic stroke due to intracranial anterior circulation occlusion. IMS III was terminated due to futility but showed evidence of potential treatment benefit in some patient subgroups, including those with NIHSS\u2009\u2265\u200920. The pooled analysis included all patients in this subgroup from both trials who were treated with IV tPA within 3 hours of onset. However, NIHSS was defined at the time of randomization in MR CLEAN, which was often several hours after starting IV tPA. Thus, an additional exploratory pooled analysis was performed using only those patients from IMS III who had NIHSS\u2009\u2265\u200920 at 40 minutes after starting IV tPA to better approximate MR CLEAN population.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe primary analysis was a logistic ordinal regression on modified Rankin Scale (mRS) at 90 days. The secondary analysis was logistic regression on dichotomized (0-2 vs 3-6) mRS at 90 days.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe pooled analysis included 342 patients (191 in endovascular group vs 151 receiving IV tPA alone). The ordinal analysis of mRS at 90 days favored endovascular intervention with a consistent shift in mRS in both trials and pooled data (adjusted OR, 1.81; 95% CI, 1.21 to 2.70). The dichotomized analysis revealed that 24.1% of patients in the endovascular group had mRS 0 to 2 vs 13.9% receiving IV tPA alone (adjusted OR, 1.85; 95% CI, 1.03 to 3.33).\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThe exploratory pooled analysis using those patients in IMS III who had NIHSS\u2009\u2265\u200920 at 40 minutes after starting IV tPA included 290 patients (157 in the endovascular group vs 133 receiving IV tPA alone). The following change in NIHSS score occurred in IMS III from pretreatment to 40 minutes: 16 patients worsened to NIHSS\u2009\u2265\u200920, and 68 patients improved to NIHSS\u2009\u0026lt;\u200920.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe ordinal analysis of mRS at 90 days favored endovascular intervention (adjusted OR, 2.07; 95% CI, 1.33 to 3.20). Dr Broderick highlighted that 78% of patients were still not functionally independent even after receiving endovascular therapy in addition to IV tPA. The dichotomized analysis showed that 22.3% of patients had mRS 0 to 2 in the endovascular group vs 10.5% receiving IV tPA alone (adjusted OR, 2.65; 95% CI, 1.31 to 5.34).\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EDr Broderick concluded that endovascular therapy after IV tPA improved outcome at 90 days for patients with severe stroke, with no increase in mortality. Also IV tPA treatment was associated with improvement to NIHSS\u2009\u0026lt;\u200920 in approximately a third of patients in the IMS III subgroup of those with NIHSS\u2009\u2265\u200920. He also called for a thoughtful consideration of triage in regional communities for patients with severe stroke who are candidates for endovascular therapy.\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\/11.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"}