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Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic Stroke

By Currents Editor posted 02-25-2021 13:10


Journal of the American Medical Association (01/19/21) 325(3):234  DOI:10.1001/jama.2020.23523
Zi, Wenjie; Qiu, Zhongming; Li, Fengli; et al.

Research out of China investigated whether endovascular treatment by itself would be just as effective as endovascular treatment plus I.V. alteplase in achieving 90-day functional independence in certain stroke patients. The study enrolled 234 adults with acute ischemic stroke due to large vessel occlusion, all of whom qualified for I.V. thrombolysis. Approximately half of the participants were randomly assigned to endovascular thrombectomy only, with the remainder allocated to a standard dose of I.V. alteplase in conjunction with endovascular thrombectomy. The trial ended early due to efficacy after 234 of a planned 970 patients had undergone randomization; all 234 patients completed the study. The primary outcome, evaluated at 90 days, was the share of patients in each treatment arm who achieved functional independence. Follow-up revealed that 54.3% of participants in the single-therapy group met that endpoint, compared with 46.6% of participants in the combined-therapy group. The -10% threshold to demonstrate noninferiority was satisfied, suggesting that endovascular thrombectomy alone promotes functional independence in stroke patients as well as the standard approach of endovascular treatment paired with I.V. alteplase.


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