Nav: Home

Direct catheter-based thrombectomy equal to bridging thrombolysis in ischemic stroke

August 27, 2016

Rome, Italy - 27 Aug 2016: Direct catheter-based thrombectomy is equally effective to bridging thrombolysis in the treatment of acute ischaemic stroke, according to results from the observational PRAGUE-16 registry study presented at ESC Congress 2016 today.1

"If left untreated, acute ischaemic stroke caused by a major artery occlusion results in death for up to half of patients and an additional 40% to 50% are left permanently disabled," said principal investigator Professor Petr Widimsky, head of the Third Faculty of Medicine, Charles University, Prague, Czech Republic. "In other words, without treatment only a few patients with major ischaemic stroke survive without severe sequelae."

Functionally independent survival (defined as a modified Rankin Scale2 score of 0-2) after these major strokes increases to approximately 20% to 30% with thrombolytic treatment in specialised stroke units. But the majority of patients still die or remain permanently disabled.

In 2015 several randomised trials demonstrated that 45% to 50% of patients can survive and be functionally independent with catheter-based (endovascular) mechanical thrombectomy. If the intervention is performed very early (within three hours from stroke onset), the results are even better - up to 70% of patients may return to normal daily life. Thus, catheter-based mechanical thrombectomy is now recommended for all patients with acute ischaemic stroke caused by a major artery occlusion.3

However, many questions remain, of which two were investigated in this pilot study. First, whether direct (without thrombolysis) cathether-based thrombectomy (d-CBT) can achieve comparable results to thrombectomy performed after intravenous ("bridging") thrombolysis. And second, whether catheter-based thrombectomy performed in interventional cardiology departments (when no interventional neuroradiology department is available) can achieve results comparable to neuroradiology settings.

Professor Widimsky said: "The study aim was to evaluate the feasibility and safety of d-CBT performed in close cooperation between cardiologists, neurologists and radiologists - a true interdisciplinary approach."

PRAGUE-164 was a prospective, observational pilot registry study. It included 103 patients who presented within six hours from the onset of moderate to severe acute ischaemic stroke. Patients had an occluded major cerebral artery but no large ischaemia yet on a computed tomography (CT) scan. The attending neurologist decided whether patients received d-CBT or bridging thrombolysis plus CBT based on the clinical picture and CT scan. The intervention was performed within 60 minutes of the CT scan.

Some 73 patients received d-CBT and 30 had bridging thrombolysis plus CBT. Good functional outcome (defined as a modified Rankin Scale score of 0-2 after 90 days) was achieved in 41% patients overall with similar results between the two groups (table 1).

Professor Widimsky said: "In our study, 41% of patients who received direct catheter-based thrombectomy had good functional recovery. This compares to 48% of patients given this intervention in seven randomised trials5 performed in expert neuroradiology units. However, our outcomes are significantly better than patients in the trials who received medical therapy (intravenous thrombolysis) alone, of whom only 30% recovered."

He concluded: "Our findings suggest that direct catheter-based thrombectomy performed in a timely manner may be an alternative to thrombectomy after bridging thrombolysis. Furthermore, in regions with no (or limited) interventional neuroradiology services, modern stroke treatment might be offered via interventional cardiology services in close cooperation with neurologists and radiologists. However, both of these preliminary conclusions should be confirmed by larger multicentre studies or large international registries."
-end-
Table 1. Outcomes after direct CBT and bridging thrombolysis plus CBT Abbreviations: CBT (cathether-based thrombectomy); mRS (modified Rankin Scale); NIHSS (National Institutes of Health Stroke Scale); SAH (subarachnoid haemorrhage); TICI (Thrombolysis in Cerebral Infarction); CT (computed tomography)

Notes to editors

Sources of funding: The administrative costs were covered by the Charles University Cardiovascular Research Program P35. The interventional procedures are routinely covered by the health insurance in the Czech Republic.

Disclosures: None

References and notes

1Professor Petr Widimsky will present the abstract "Feasibility and safety of direct catheter-based thrombectomy in the treatment of acute ischemic stroke. Prospective registry PRAGUE-16" during:
  • The press conference "Stroke and Arrhythmia: Life or Death" on 27 August at 15:00 to 16:00
  • The session "Registries coronary artery disease, stroke and intervention" on 29 August at 16:30 to 18:00 in room Sarajevo - Village 2
2The modified Rankin Scale (mRS) assesses disability in patients who have suffered a stroke. A score of 0 is no disability, 5 is disability requiring constant care for all needs; 6 is death.

32015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020-3035. doi: 10.1161/STR.0000000000000074.

4PRAGUE refers to a series of academic randomised trials coordinated by the Cardiocentre, Charles University, Prague. The acronym not only reflects the name of this city, but also the abbreviation of the first study from this series (published in 2000) - PRimary Angioplasty in patients with myocardial infarction transferred from General community hospitals to angioplasty Units of tertiary cardiology centres with or without Emergency thrombolysis.

5MR CLEAN, ESCAPE, EXTEND IA, SWIFT PRIME, REVASCAT, THERAPY, THRACE

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 120 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2016

ESC Congress is the world's largest gathering of cardiovascular professionals contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2016 takes place 27 to 31 August at the Fiera di Roma in Rome, Italy. The scientific programme is here. More information is available from the ESC Press Office at press@escardio.org

European Society of Cardiology

Related Thrombectomy Articles:

Antioxidant treatment in acute ischemic stroke may delay the onset of Alzheimer's dementia
There is a considerable overlap between vascular risk factors and risk factors of Alzheimer's disease (AD).
Less than 20% of Americans have rapid access to endovascular thrombectomy for stroke
Timely treatment is critical for stroke victims, yet only 19.8% of the U.S. population can access a stroke center capable of endovascular thrombectomy to remove a large clot in 15 minutes or less by ambulance, according to researchers from UTHealth.
Mechanical clot removal without clot busters may be sufficient stroke treatment
Mechanical clot removal alone may be as effective as combining it with intravenous (IV) clot-busting medications for stroke patients.
Lower dose of newer clot-buster may be appropriate for some stroke patients
In a comparison of 0.25mg/kg and 0.40mg/kg doses of the newer and more convenient clot-busting medication tenecteplase, there was no advantage in increasing the dose above 0.25mg/kg in stroke patients who planned to have mechanical clot retrieval.
Both simple and advanced imaging can predict best stroke patients for thrombectomy
Both simple and advanced computed tomography (CT) were effective in accurately predicting which stroke patients would benefit from endovascular thrombectomy to remove a large cerebral clot, but together they were even better, reported researchers at McGovern Medical School at UTHealth in Houston.
New algorithm expands neurologists' ability to assess for clot-removing procedure
An algorithm developed by faculty at The University of Texas Health Science Center at Houston (UTHealth) can help physicians outside of major stroke treatment centers assess whether a patient suffering from ischemic stroke would benefit from an endovascular procedure to remove a clot blocking an artery.
Transport by mobile stroke units get patients quicker treatment than ambulance
Every second counts for stroke patients, as studies show they can lose up to 27 million brain cells per minute.
Clinical trial reveals potential for treating larger strokes with thrombectomy
Building on research results published today in JAMA Neurology showing patients with larger ischemic strokes could benefit from endovascular thrombectomy, an international, multicenter Phase III clinical trial will be starting at The University of Texas Health Science Center at Houston (UTHealth).
South Florida partnership using data to guide stroke triage decisions
A progressive Emergency Medical Services (EMS)-driven partnership in South Florida has expedited access to lifesaving care for stroke patients.
Physician experience and practice area affects decision-making for endovascular treatment
A new study presented today at the Society of NeuroInterventional Surgery's (SNIS) 16th Annual Meeting found significant differences in decision-making for endovascular treatment (EVT) when the physician's experience with EVT use and practice area were taken into consideration.
More Thrombectomy News and Thrombectomy Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Clint Smith
The killing of George Floyd by a police officer has sparked massive protests nationwide. This hour, writer and scholar Clint Smith reflects on this moment, through conversation, letters, and poetry.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.