Stroke, ischemic, cerebral infarction: Thrombolysis and/or Endovascular treatment versus standard medical care
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2018 01 04;378(1):11-21 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, 6 to 24 h of onset, proximal arterial occlusion in the anterior cerebral circulation, mismatch between deficit and Infarct The Use of
endovascular treatment: thrombectomy, late
As Treatment, Acute
Is better Than
standard care
To improve at 3 months functional independence (49% thrombectomy VS 13% controls). Mortality was not different (19% thrombectomy VS 18% controls)
N Engl J Med. 2008 Sep 25;359(13):1317-29 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, first 3-4 h of onset The Use of
thrombolysis, alteplase, 3 to 4.5 hours after the onset of symptoms
As Treatment, Acute
Is better Than
placebo
To improve number of patients in Rankin scale 0 or 1 at 3 months: 52.4% alteplase VS 45.2% placebo. Intracranial haemorrhage was more frequent. Mortality was not sig different: 7.7% alteplase VS 8.4% placebo
Lancet. 2012 Jun 23;379(9834):2364-72 Systematic Review
IN stroke, ischemic, cerebral infarction, first 3-6 h of onset, elder patients The Use of
thrombolysis, alteplase, recombinant tissue plasminogen activator (rt-PA)
As Treatment, Acute
Is better Than
no thrombolysis
To increase the number of patients being alive and independent (46% r-tPa VS 42% controls) specially when treated in the first 3 hours (41% VS 31%). But did not reduced mortality, in fact it increased it initially
Lancet. 2012 Jun 23;379(9834):2352-63 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, first 4-5 h of onset, elder patients The Use of
thrombolysis, recombinant tissue plasminogen activator (rt-PA)
As Treatment, Acute
Is equal Than
placebo
To modify the number of patients alive and independent at 6 months: 37% with r-tPa VS 35% controls. Equally effective in patients > 80 years old
N Engl J Med. 2017 04 06;376(14):1341-1349 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, first 6 h of onset, proximal arterial occlusion in the anterior cerebral circulation The Use of
endovascular treatment: thrombectomy plus stenting, on top of thrombolysis
As Treatment, Acute
Is better Than
thrombolysis alone
To improve, at 2 years, overall mortality (26% endovascular VS 31% thrombolysis alone), distribution of outcomes on the modified Rankin scale and QoL (mean 0.48 endovascular VS 0.38 not endovasc)
N Engl J Med. 2015 Jan 1;372(1):11-20 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, first 6 h of onset, proximal arterial occlusion in the anterior cerebral circulation The Use of
intraarterial treatment: thrombectomy plus stenting, on top of thrombolysis
As Treatment, Acute
Is better Than
thrombolysis alone
To improve functional independence (modified Rankin score, 0 to 2) at 3 months: 33% intrarterial Tt VS 19% thrombolysis alone. No significant differences in mortality or the occurrence of symptomatic intracerebral hemorrhage.