Improving Outcomes in Stroke
Improving Outcomes in Stroke
Trials have shown that endovascular thrombectomy within 6 hours after the onset of ischemic stroke symptoms has a clinical benefit, but the effect after more than 6 hours is not known. New research findings are summarized in a short video.
See the related NEJM article: http://www.nejm.org/doi/full/10.1056/…
Content
5.68 -> For patients with acute ischemic stroke,
endovascular thrombectomy within six
10.36 -> hours after the onset of symptoms can
improve outcomes. Patients with a
14.35 -> disproportionately high NIH Stroke score
given the size of the ischemic area on
19.09 -> perfusion imaging (so called "clinical
infarct mismatch") are more likely to
23.5 -> recover function after thrombectomy. The
DAWN trial tested whether patients in
28.029 -> whom brain imaging showed proximal
anterior cerebral vessel occlusion and
32.11 -> clinical infarct mismatch would benefit
from thrombectomy 6 to 24 hours after
37.27 -> the onset of an ischemic stroke. Two hundred six patients were randomly assigned to
41.71 -> receive thrombectomy or standard medical
care. The patients were then assessed at
45.97 -> 90 days after stroke. The primary outcome
of post-stroke disability on the Utility-
51.19 -> Weighted modified Rankin Scale showed a mean score of 5.5 for the
55.63 -> thrombectomy group versus 3.4 for the standard care group, a
59.46 -> statistically significant difference.
Functional independence was achieved in
63.61 -> 49% of patients in the
thrombectomy group versus 13%
67.24 -> in the standard care group.
Procedural complications occurred in
71.29 -> 7% of patients in the
thrombectomy group. The rate of other
74.83 -> adverse events, such as symptomatic
intracranial hemorrhage and death, was
78.61 -> similar between groups. The trial was
stopped at 31 months when a
82.33 -> planned interim analysis showed the
superiority of thrombectomy. The authors
86.53 -> conclude that in patients with acute
anterior circulation stroke with
90.07 -> clinical-infarct mismatch, thrombectomy
performed within six to 24 hours
94.93 -> significantly reduced disability and
improved functional independence at
98.92 -> 90 days as compared with standard
medical care. Full trial results are
103.09 -> available at NEJM.org.
Source: https://www.youtube.com/watch?v=uoZPWMMGxYY