Direct thrombectomy, bridging therapy confer similar functional outcomes in stroke

 So both are complete failures in getting to 100% recovery? No measurement of that has to mean complete failure at that.

Direct thrombectomy, bridging therapy confer similar functional outcomes in stroke

Results of a meta-analysis published in Neurology determined there was no difference in functional outcomes between direct thrombectomy and combination with bridging IV thrombolysis among Asian patients with large vessel occlusion stroke.

“The safety and efficacy of intravenous thrombolysis (IVT) for patients with large vessel occlusion (LVO) who are also eligible for endovascular stroke treatment has been questioned,” Aristeidis Katsanos, MD, a neurologist and stroke fellow at McMaster University and the Population Health Research Institute, and colleagues wrote. “Direct endovascular thrombectomy (dEVT), bypassing the administration of any intravenous thrombolytic agent, has been suggested as an alternative therapeutic approach to the combination of IVT followed by endovascular treatment for acute ischemic stroke (AIS) patients who are eligible for both treatment modalities and present at a site that can offer prompt endovascular treatment. The hypothesis that dEVT is a non-inferior option to the current standard of care combination of IVT and endovascular thrombectomy, referred also as bridging therapy (BT), has been evaluated in the setting of multiple observational studies and recently published randomized-controlled clinical trials (RCTs).”

Researchers detected no difference in functional outcomes between direct thrombectomy and combination with bridging IV thrombolysis among Asian patients with large vessel occlusion stroke. Source: Adobe Stock

Katsanos and colleagues conducted a systematic review and meta-analysis to assess the current evidence on the relative efficacy and safety of dEVT compared with BT in Asian patients with AIS. They noted a median age of 70 years in the overall study population; 44% were women.

The study included patients with LVO AIS who were eligible for both therapeutic options presenting within 4.5 hours from stroke onset. Through searching Medline and Scopus, investigators identified three randomized controlled trials that included a total of 1,092 patients. The probability of a modified Rankin scale (mRS) score of 0-2 at 3 months served as the primary outcome.

Investigators observed no different between dEVT and BT with regard to outcomes of mRS 0-2 (OR = 1.08; 95% CI, 0.85-1.38; adjusted OR = 1.11; 95% CI, 0.76-1.63), mRS 0-1 (OR = 1.10; 95% CI, 0.84-1.43; adjusted OR = 1.16; 95% CI, 0.84-1.61) and functional improvement at 3 months (common OR = 1.08; 95% CI, 0.88-1.34; adjusted common OR = 1.09; 95% CI, 0.86-1.37). Katsanos and colleagues noted patients who received dEVT compared with BT had a significantly poorer chance of successful recanalization prior to the endovascular procedure (OR = 0.37; 95% CI, 0.18-0.77).

According to researchers, although patients who received dEVT compared with BT had reduced intracranial bleeding rates (OR = 0.67; 95% CI, 0.49-0.92), there was no significant difference in the likelihood of symptomatic intracranial hemorrhage. They also reported no differences between the groups regarding all-cause mortality, serious adverse events or procedural complications.

“Effect estimates from available RCTs, presented in the current systematic review and meta-analysis, when compared to those provided by observational studies, raise concerns for heterogeneity in inclusion criteria and the possibility for selection bias within published cohorts,” Katsanos and colleagues wrote. “… The issue of generalizability of the evidence from individual RCTs and the results from the current meta-analysis beyond the Asian population deserves particular attention.”

 

Haemorrhagic Strokes More Common in Asians Than Other Ethnicities in U.S.

I don't know what you do about this except hope like hell that interventions will soon be enough to get everyone 100% recovered.
http://dgnews.docguide.com/haemorrhagic-strokes-more-common-asians-other-ethnicities-us?

By Brian Hoyle
SAN DIEGO, California -- October 18, 2017 -- In the United States, haemorrhagic strokes are more frequent among patients of Asian ethnicity compared with those of other ethnicities, according to results of a large, retrospective study presented at the 142nd Annual Meeting of the American Neurological Association (ANA).
“In the U.S., Asian patients [also] appear to have a higher rate of in-hospital mortality after stroke compared with patients of other ethnicities,” added lead author Antonio Moya, MD, Weill Cornell Medical Center, New York, New York, and colleagues, speaking at a poster presentation here on October 15.
Dr. Moya and colleagues analysed data from the Nationwide Inpatients Sample database, 2002 to 2012 -- the largest publicly available all-payer inpatient healthcare database in the U.S. The team used standard codes to retrieve medical records of ischaemic and haemorrhagic stroke cases. The primary outcome was the relative proportion of haemorrhagic strokes compared with ischaemic strokes. In-hospital death and number of discharges were secondary outcomes.
The analysis included 4,449,516 stroke patients in the general population. The majority had experienced ischaemic stroke (3,794,438 or 85.3%) with the remaining 655,078 (14.7%) having had a haemorrhagic stroke.
Comparing the Asian population (n = 98,965 or 2.2%) with the non-Asian population (n = 4,350,551 or 97.8%) revealed significant differences (all P < .001) in median age (71 vs 73 years), proportion of males (50.5% vs 46.4%), prevalence of diabetes mellitus (37.1% vs 31.4%), hypertension (82.3% vs 75.6%), hyperlipidaemia (41.3% vs 35.9%), coronary-artery disease (18.6% vs 25.0%), congestive heart failure (8.4% vs 12.5%), atrial fibrillation (14.7% vs 17.2%), and chronic kidney disease (8.4% vs 7.1%).
The proportion of haemorrhagic strokes was higher for Asians than for the general population (24.0% vs 14.5%; P < .001).
A multivariate logistic regression analysis adjusting for age, sex, comorbidities, hospital characteristics, complications, mechanical ventilation, procedures, and withdrawal of care revealed that in-hospital mortality was more likely in Asian patients compared with the general population (9,731 [9.8%] vs 378,771 [8.7%]; odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.19 to 1.35; P < .001).
No difference was evident between Asians and the general population concerning home discharge (34.5% vs 33.6%; OR: 0.92, 95% CI: 0.86 to 1.03; P = .865). The researchers observed no appreciable differences in stroke subtypes between Asians and the general population.
The majority of patients in this study were in relatively good health, with a low risk of another stroke (Modified Charlson’s Index 0: 39.0% vs 34.9%).
Studies undertaken in Asia have indicated that a markedly higher proportion of the population experiences haemorrhagic stroke compared with elsewhere in the world. Whether this reflects a genetic disposition or an environmental influence (or aspects of both) has been unclear. If the environment were the dominant influence, then a lower incidence of haemorrhagic stroke might be expected among Asians living in the United States, Dr. Moya noted.
More studies are required to determine the dominant cause of this increased risk.
Funding for this study was provided by the National Institutes of Health, Bethesda, Maryland and the Florence Gould Endowment for Discovery in Stroke.
[Presentation title: Incidence of Ischemic and Hemor