Endovascular therapy is effective and safe for patients with severe ischemic stroke: Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data

Joseph P. Broderick; Olvert A. Berkhemer; Yuko Y. Palesch; Diederik W.J. Dippel; Lydia D. Foster; Yvo B.W.E.M. Roos; Aad Van Der Lugt; Thomas A. Tomsick; Charles B.L.M. Majoie; Wim H. Van Zwam; Andrew M. Demchuk; Robert J. Van Oostenbrugge; Pooja Khatri; Hester F. Lingsma; Michael D. Hill; Bob Roozenbeek; Edward C. Jauch; Tudor G. Jovin; Bernard Yan; Rüdiger Von Kummer; Carlos A. Molina; Mayank Goyal; Wouter J. Schonewille; Mikael Mazighi; Stefan T. Engelter; Craig S. Anderson; Judith Spilker; Janice Carrozzella; Karla J. Ryckborst; L. Scott Janis; Kit N. Simpson

doi:10.1161/STROKEAHA.115.011397

Endovascular therapy is effective and safe for patients with severe ischemic stroke: Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data

Joseph P. Broderick^*
, Olvert A. Berkhemer
, Yuko Y. Palesch
, Diederik W.J. Dippel
, Lydia D. Foster
, Yvo B.W.E.M. Roos
, Aad Van Der Lugt
, Thomas A. Tomsick
, Charles B.L.M. Majoie
, Wim H. Van Zwam
, Andrew M. Demchuk
, Robert J. Van Oostenbrugge
, Pooja Khatri
, Hester F. Lingsma
, Michael D. Hill
, Bob Roozenbeek
, Edward C. Jauch
, Tudor G. Jovin
, Bernard Yan
, Rüdiger Von Kummer

Carlos A. Molina, Mayank Goyal, Wouter J. Schonewille, Mikael Mazighi, Stefan T. Engelter, Craig S. Anderson, Judith Spilker, Janice Carrozzella, Karla J. Ryckborst, L. Scott Janis, Kit N. Simpson

^*Corresponding author for this work

University of Cincinnati
Amsterdam University Medical Centers
Medical University of South Carolina
Erasmus MC
Maastricht University
University of Calgary
University of Pittsburgh
University of Melbourne
Technische Universität Dresden
Vall d'Hebron Hospital Universitari
Utrecht University
St. Antonius Ziekenhuis
Université Paris Cité
University of Basel
Royal Prince Alfred Hospital
National Institutes of Health

Research output: Contribution to journal › Article › peer-review

43 Scopus citations

Abstract

Background and Purpose - We assessed the effect of endovascular treatment in acute ischemic stroke patients with severe neurological deficit (National Institutes of Health Stroke Scale score, ≥20) after a prespecified analysis plan. Methods - The pooled analysis of the Interventional Management of Stroke III (IMS III) and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trials included participants with an National Institutes of Health Stroke Scale score of ≥20 before intravenous tissue-type plasminogen activator (tPA) treatment (IMS III) or randomization (MR CLEAN) who were treated with intravenous tPA ≤3 hours of stroke onset. Our hypothesis was that participants with severe stroke randomized to endovascular therapy after intravenous tPA would have improved 90-day outcome (distribution of modified Rankin Scale scores), when compared with those who received intravenous tPA alone. Results - Among 342 participants in the pooled analysis (194 from IMS III and 148 from MR CLEAN), an ordinal logistic regression model showed that the endovascular group had superior 90-day outcome compared with the intravenous tPA group (adjusted odds ratio, 1.78; 95% confidence interval, 1.20-2.66). In the logistic regression model of the dichotomous outcome (modified Rankin Scale score, 0-2, or functional independence), the endovascular group had superior outcomes (adjusted odds ratio, 1.97; 95% confidence interval, 1.09-3.56). Functional independence (modified Rankin Scale score, ≤2) at 90 days was 25% in the endovascular group when compared with 14% in the intravenous tPA group. Conclusions - Endovascular therapy after intravenous tPA within 3 hours of symptom onset improves functional outcome at 90 days after severe ischemic stroke.

Original language	English
Pages (from-to)	3416-3422
Number of pages	7
Journal	Stroke
Volume	46
Issue number	12
DOIs	https://doi.org/10.1161/STROKEAHA.115.011397
State	Published - 1 Dec 2015
Externally published	Yes

Keywords

clinical trial
endovascular procedures
stroke
tissue-type plasminogen activator

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10.1161/STROKEAHA.115.011397

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Broderick, J. P., Berkhemer, O. A., Palesch, Y. Y., Dippel, D. W. J., Foster, L. D., Roos, Y. B. W. E. M., Van Der Lugt, A., Tomsick, T. A., Majoie, C. B. L. M., Van Zwam, W. H., Demchuk, A. M., Van Oostenbrugge, R. J., Khatri, P., Lingsma, H. F., Hill, M. D., Roozenbeek, B., Jauch, E. C., Jovin, T. G., Yan, B., ... Simpson, K. N. (2015). Endovascular therapy is effective and safe for patients with severe ischemic stroke: Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data. Stroke, 46(12), 3416-3422. https://doi.org/10.1161/STROKEAHA.115.011397

Broderick, Joseph P. ; Berkhemer, Olvert A. ; Palesch, Yuko Y. et al. / Endovascular therapy is effective and safe for patients with severe ischemic stroke : Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data. In: Stroke. 2015 ; Vol. 46, No. 12. pp. 3416-3422.

@article{98cc1f47b00c4e6e8f5c7e3f0784bb02,

title = "Endovascular therapy is effective and safe for patients with severe ischemic stroke: Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data",

abstract = "Background and Purpose - We assessed the effect of endovascular treatment in acute ischemic stroke patients with severe neurological deficit (National Institutes of Health Stroke Scale score, ≥20) after a prespecified analysis plan. Methods - The pooled analysis of the Interventional Management of Stroke III (IMS III) and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trials included participants with an National Institutes of Health Stroke Scale score of ≥20 before intravenous tissue-type plasminogen activator (tPA) treatment (IMS III) or randomization (MR CLEAN) who were treated with intravenous tPA ≤3 hours of stroke onset. Our hypothesis was that participants with severe stroke randomized to endovascular therapy after intravenous tPA would have improved 90-day outcome (distribution of modified Rankin Scale scores), when compared with those who received intravenous tPA alone. Results - Among 342 participants in the pooled analysis (194 from IMS III and 148 from MR CLEAN), an ordinal logistic regression model showed that the endovascular group had superior 90-day outcome compared with the intravenous tPA group (adjusted odds ratio, 1.78; 95\% confidence interval, 1.20-2.66). In the logistic regression model of the dichotomous outcome (modified Rankin Scale score, 0-2, or functional independence), the endovascular group had superior outcomes (adjusted odds ratio, 1.97; 95\% confidence interval, 1.09-3.56). Functional independence (modified Rankin Scale score, ≤2) at 90 days was 25\% in the endovascular group when compared with 14\% in the intravenous tPA group. Conclusions - Endovascular therapy after intravenous tPA within 3 hours of symptom onset improves functional outcome at 90 days after severe ischemic stroke.",

keywords = "clinical trial, endovascular procedures, stroke, tissue-type plasminogen activator",

author = "Broderick, \{Joseph P.\} and Berkhemer, \{Olvert A.\} and Palesch, \{Yuko Y.\} and Dippel, \{Diederik W.J.\} and Foster, \{Lydia D.\} and Roos, \{Yvo B.W.E.M.\} and \{Van Der Lugt\}, Aad and Tomsick, \{Thomas A.\} and Majoie, \{Charles B.L.M.\} and \{Van Zwam\}, \{Wim H.\} and Demchuk, \{Andrew M.\} and \{Van Oostenbrugge\}, \{Robert J.\} and Pooja Khatri and Lingsma, \{Hester F.\} and Hill, \{Michael D.\} and Bob Roozenbeek and Jauch, \{Edward C.\} and Jovin, \{Tudor G.\} and Bernard Yan and \{Von Kummer\}, R{\"u}diger and Molina, \{Carlos A.\} and Mayank Goyal and Schonewille, \{Wouter J.\} and Mikael Mazighi and Engelter, \{Stefan T.\} and Anderson, \{Craig S.\} and Judith Spilker and Janice Carrozzella and Ryckborst, \{Karla J.\} and Janis, \{L. Scott\} and Simpson, \{Kit N.\}",

note = "Publisher Copyright: {\textcopyright} 2015 American Heart Association, Inc.",

year = "2015",

month = dec,

day = "1",

doi = "10.1161/STROKEAHA.115.011397",

language = "Ingl{\'e}s",

volume = "46",

pages = "3416--3422",

journal = "Stroke",

issn = "0039-2499",

publisher = "Wolters Kluwer Health",

number = "12",

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Broderick, JP, Berkhemer, OA, Palesch, YY, Dippel, DWJ, Foster, LD, Roos, YBWEM, Van Der Lugt, A, Tomsick, TA, Majoie, CBLM, Van Zwam, WH, Demchuk, AM, Van Oostenbrugge, RJ, Khatri, P, Lingsma, HF, Hill, MD, Roozenbeek, B, Jauch, EC, Jovin, TG, Yan, B, Von Kummer, R, Molina, CA, Goyal, M, Schonewille, WJ, Mazighi, M, Engelter, ST, Anderson, CS, Spilker, J, Carrozzella, J, Ryckborst, KJ, Janis, LS & Simpson, KN 2015, 'Endovascular therapy is effective and safe for patients with severe ischemic stroke: Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data', Stroke, vol. 46, no. 12, pp. 3416-3422. https://doi.org/10.1161/STROKEAHA.115.011397

Endovascular therapy is effective and safe for patients with severe ischemic stroke: Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data. / Broderick, Joseph P.; Berkhemer, Olvert A.; Palesch, Yuko Y. et al.
In: Stroke, Vol. 46, No. 12, 01.12.2015, p. 3416-3422.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Endovascular therapy is effective and safe for patients with severe ischemic stroke

T2 - Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data

AU - Broderick, Joseph P.

AU - Berkhemer, Olvert A.

AU - Palesch, Yuko Y.

AU - Dippel, Diederik W.J.

AU - Foster, Lydia D.

AU - Roos, Yvo B.W.E.M.

AU - Van Der Lugt, Aad

AU - Tomsick, Thomas A.

AU - Majoie, Charles B.L.M.

AU - Van Zwam, Wim H.

AU - Demchuk, Andrew M.

AU - Van Oostenbrugge, Robert J.

AU - Khatri, Pooja

AU - Lingsma, Hester F.

AU - Hill, Michael D.

AU - Roozenbeek, Bob

AU - Jauch, Edward C.

AU - Jovin, Tudor G.

AU - Yan, Bernard

AU - Von Kummer, Rüdiger

AU - Molina, Carlos A.

AU - Goyal, Mayank

AU - Schonewille, Wouter J.

AU - Mazighi, Mikael

AU - Engelter, Stefan T.

AU - Anderson, Craig S.

AU - Spilker, Judith

AU - Carrozzella, Janice

AU - Ryckborst, Karla J.

AU - Janis, L. Scott

AU - Simpson, Kit N.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background and Purpose - We assessed the effect of endovascular treatment in acute ischemic stroke patients with severe neurological deficit (National Institutes of Health Stroke Scale score, ≥20) after a prespecified analysis plan. Methods - The pooled analysis of the Interventional Management of Stroke III (IMS III) and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trials included participants with an National Institutes of Health Stroke Scale score of ≥20 before intravenous tissue-type plasminogen activator (tPA) treatment (IMS III) or randomization (MR CLEAN) who were treated with intravenous tPA ≤3 hours of stroke onset. Our hypothesis was that participants with severe stroke randomized to endovascular therapy after intravenous tPA would have improved 90-day outcome (distribution of modified Rankin Scale scores), when compared with those who received intravenous tPA alone. Results - Among 342 participants in the pooled analysis (194 from IMS III and 148 from MR CLEAN), an ordinal logistic regression model showed that the endovascular group had superior 90-day outcome compared with the intravenous tPA group (adjusted odds ratio, 1.78; 95% confidence interval, 1.20-2.66). In the logistic regression model of the dichotomous outcome (modified Rankin Scale score, 0-2, or functional independence), the endovascular group had superior outcomes (adjusted odds ratio, 1.97; 95% confidence interval, 1.09-3.56). Functional independence (modified Rankin Scale score, ≤2) at 90 days was 25% in the endovascular group when compared with 14% in the intravenous tPA group. Conclusions - Endovascular therapy after intravenous tPA within 3 hours of symptom onset improves functional outcome at 90 days after severe ischemic stroke.

AB - Background and Purpose - We assessed the effect of endovascular treatment in acute ischemic stroke patients with severe neurological deficit (National Institutes of Health Stroke Scale score, ≥20) after a prespecified analysis plan. Methods - The pooled analysis of the Interventional Management of Stroke III (IMS III) and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trials included participants with an National Institutes of Health Stroke Scale score of ≥20 before intravenous tissue-type plasminogen activator (tPA) treatment (IMS III) or randomization (MR CLEAN) who were treated with intravenous tPA ≤3 hours of stroke onset. Our hypothesis was that participants with severe stroke randomized to endovascular therapy after intravenous tPA would have improved 90-day outcome (distribution of modified Rankin Scale scores), when compared with those who received intravenous tPA alone. Results - Among 342 participants in the pooled analysis (194 from IMS III and 148 from MR CLEAN), an ordinal logistic regression model showed that the endovascular group had superior 90-day outcome compared with the intravenous tPA group (adjusted odds ratio, 1.78; 95% confidence interval, 1.20-2.66). In the logistic regression model of the dichotomous outcome (modified Rankin Scale score, 0-2, or functional independence), the endovascular group had superior outcomes (adjusted odds ratio, 1.97; 95% confidence interval, 1.09-3.56). Functional independence (modified Rankin Scale score, ≤2) at 90 days was 25% in the endovascular group when compared with 14% in the intravenous tPA group. Conclusions - Endovascular therapy after intravenous tPA within 3 hours of symptom onset improves functional outcome at 90 days after severe ischemic stroke.

KW - clinical trial

KW - endovascular procedures

KW - stroke

KW - tissue-type plasminogen activator

UR - https://www.scopus.com/pages/publications/84947904466

U2 - 10.1161/STROKEAHA.115.011397

DO - 10.1161/STROKEAHA.115.011397

M3 - Artículo

C2 - 26486865

AN - SCOPUS:84947904466

SN - 0039-2499

VL - 46

SP - 3416

EP - 3422

JO - Stroke

JF - Stroke

IS - 12

ER -

Broderick JP, Berkhemer OA, Palesch YY, Dippel DWJ, Foster LD, Roos YBWEM et al. Endovascular therapy is effective and safe for patients with severe ischemic stroke: Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data. Stroke. 2015 Dec 1;46(12):3416-3422. doi: 10.1161/STROKEAHA.115.011397

Endovascular therapy is effective and safe for patients with severe ischemic stroke: Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data

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Keywords

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