Deans' stroke musings: Direct mechanical intervention versus combined intravenous and mechanical intervention in large artery anterior circulation stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, April 7, 2017

Direct mechanical intervention versus combined intravenous and mechanical intervention in large artery anterior circulation stroke

The useful data comparison from this should have been time to Direct mechanical intervention vs. combined intravenous and mechanical intervention. That would be more useful than whatever they did here. I think time to recover reperfusion is the key metric rather than type of intervention. But a great stroke association president would know this and get researchers to interpret their data correctly. Using the Rankin scale as a measurement device for stroke disability is incredibly stupid. It has nothing objective in it at all except for 6 - death.
https://www.mdlinx.com/internal-medicine/medical-news-article/2016/04/06/6604547/?

Stroke

BroegMorvay A, et al. –

In patients with large anterior circulation stroke, direct mechanical intervention seems to be equally effective as bridging thrombolysis. A randomized trial comparing direct MT with bridging therapy is warranted.

Methods

The authors retrospectively compared clinical and radiological outcomes in 167 bridging patients with 255 patients receiving direct MT because of large artery anterior circulation stroke.
They matched all patients from the direct MT group who would have qualified for intravenous tissue–type plasminogen activator with controls from the bridging group, using multivariate and propensity score analyses.
Functional independence was defined as modified Rankin Scale score of 0 to 2.

Results

From February 2009 to August 2014, 40 patients from the direct MT group would have qualified for bridging thrombolysis but were treated with MT only.
Clinical and radiological characteristics did not differ from the bridging cohort, except for higher rates of hypercholesterolemia (P=0.019), coronary heart disease (P=0.039), and shorter intervals from symptom onset to endovascular intervention (P=0.01) in the direct MT group.
Functional independence, mortality, and intracerebral hemorrhage rates did not differ (P>0.1).
After multivariate matching analysis outcome in both groups did not differ, except for lower rates of asymptomatic intracerebral hemorrhage (P=0.023) and lower mortality (P=0.007) in the direct MT group.