MD Conference Express ISC 2013 - (Page 23)
Table 1. Stroke and Procedure Characteristics
Figure 1. Modified Rankin Scale Distribution at 90 Days
Parameter
0
n (%)
Mechanical thrombectomy only
83 (41)
Time to Treatment
2
3
4
5
6
119 (59)
n (%)
0 to 3 hours
50 (25.6)
3 to 4.5 hours
74 (37.9)
>4.5 hours
Occluded Vessel (per Core Lab)
71 (36.4)
a
mRS=0
90-Day mRS
Combined intravenous rtPA/mechanical thrombectomy
1
mRS=1
17
26
15
16
15
4
7
n (%)
Internal carotid artery terminal
36 (18)
Middle cerebral artery
160 (82)
M1
M2
28 (14)
M3
1 (0.5)b
57.9%
0%
20%
131 (67)
Procedure Characteristics
mRS=2
40%
60%
80%
100%
Favorable Outcome
mRS=modified Rankin Scale.
Reproduced with permission from VM Pereira, MD, MSc.
Mean±SD (n)
Number of passes
1.5±0.7 (202)
Stroke onset to groin puncture (min)
251±99 (195)
Groin puncture to balloon catheter placement (min)
15±10 (193)
Balloon catheter placement to TICI 2b/3 or final digital
subtraction angiogram (min)
29±27 (194)
a
6 patients could not be evaluated due to incomplete data. bProtocol violation.
rtPA=recombinant tissue plasminogen activator; SD=standard deviation; TICI=thrombolysis
in cerebral infarction.
A total of 188 patients (93%) completed the 90-day
follow-up and 14 (7%) died. Per the core lab, 160 patients
(79%) met the primary endpoint of revascularization
(thrombolysis in cerebral infarction score ≥2b) within
3 passes; 12 patients with missing endpoint data were
counted as failures. Eighteen patients (9%) required
rescue therapy, and 57.9% had a favorable outcome
(mRS score ≤2) at 90 days (Figure 1). Per adjudication
by Clinical Events Committee, 38 patients (18.8%)
experienced symptomatic intracranial hemorrhage
within 24 hours of the procedure. Fifteen patients
(7.4%) had a device- or procedure-related serious
adverse event.
Prof. Pereira said, “This nonrandomized prospective
study suggests that treatment with the Solitaire FR
device for intracranial anterior circulation strokes by
comprehensive and experienced stroke centers results
in a low risk of clinically relevant procedural and device
related complications, high revascularization rates,
and good clinical outcomes.” These results support the
further investigation of this device in a randomized
controlled trial against best medical treatment.
Clopidogrel Plus Aspirin Reduces
Risk of Recurrent Stroke: The
CHANCE Trial
Written by Phill Vinall
Transient ischemic attack (TIA) and minor stroke are
common cerebrovascular disorders after which there is
a high risk of recurrent stroke. Results from the recently
completed Clopidogrel in High-Risk Patients with Acute
Nondisabling Cerebrovascular Events study [CHANCE]
indicate that an early period of clopidogrel plus aspirin
reduces the risk of recurrent stroke in these patients
without increasing bleeding compared with aspirin alone.
The objective of the CHANCE study was to assess the
effects an early 21-day period of clopidogrel plus aspirin
versus aspirin alone on reducing the risk of a new stroke
when initiated within 24 hours of symptom onset in
patients with minor stroke (National Institutes of Health
Stroke Score [NIHSS] ≤3) or TIA (ABCD2 score ≥4). The study
design has been published [Wang Y et al. Am Heart J 2010].
Yongjun Wang, MD, Beijing Tian Tan Hospital, Beijing,
China, presented the 3-month results.
Study participants (n=5170) were randomly assigned
to receive clopidogrel (loading dose of 300 mg then
75 mg/day for up to 3 months) plus aspirin (75 mg/day
for 21 days; n=2584) or aspirin (75 mg/day for 3 months)
plus placebo (n=2586). The primary efficacy outcome was
the percentage of new strokes (ischemic or hemorrhagic)
at 3 months. The secondary efficacy outcome was a
combination of new clinical vascular events (ischemic
Official Peer-Reviewed Highlights from International Stroke Conference 2013
23
Table of Contents for the Digital Edition of MD Conference Express ISC 2013
MD Conference Express ISC 2013
Contents
Defending the Stroke Guidelines
Stroke Update: An Overview of What Is Going on in the Area of Stroke
Brain Imaging Does Not Help Identify Patients Who May Benefit From Endovascular Treatments for Acute Ischemic Stroke
MISTIE II Trial: 365-Day Results Demonstrate Improved Outcomes and Cost Benefit
Addition of AMPLATZER PFO Occluder to Medical Therapy Is Beneficial in Patients With Cryptogenic Stroke and PFO
Intraoperative CT-Guided Endoscopic Surgery for ICH [ICES]
The EMBRACE Trial: Prolonged Ambulatory Cardiac Monitoring Improves the Detection and Treatment of Atrial Fibrillation in Patients With Cryptogenic Stroke
DP-b99 Does Not Improve Recovery Following Acute Ischemic Stroke
The Secondary Prevention of Small Subcortical Strokes Trial: Blood Pressure Intervention Results
Final Results of the Solitaire FR Thrombectomy for Acute Revascularization: The STAR Trial
Clopidogrel Plus Aspirin Reduces Risk of Recurrent Stroke: The CHANCE Trial
Reversal of Chronic Hypoperfusion to Improve Cognitive Function: The RECON Trial
Cardioembolic Stroke
IMS III
Novel Anticoagulants in Vascular Neurology Practice
Wake-Up Stroke
Virtual Reality in Stroke Rehabilitation
Reward Improves Long-Term Retention of a Motor Memory Through Induction of Offline Memory Gains
MD Conference Express ISC 2013
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