Neurothrombectomy trial results: stroke systems, not just devices, make the difference
J Mocco, Kyle M Fargen, Mayank Goyal, Elad I Levy, Peter J Mitchell, Bruce CV Campbell, Charles BLM Majoie, Diederik WJ Dippel, Pooja Khatri, Michael D Hill, Jeffery L Saver
INTERNATIONAL JOURNAL OF STROKE | WILEY-BLACKWELL | Published : 2015
The overwhelming benefit demonstrated in the four recent randomized trials comparing intra-arterial therapies to medical management alone will have a transformative effect on the emergent management of strokes throughout the world. New generation neurothrombectomy devices were critical to trial success, but not the sole driver of patient outcomes in these trials. Patients in the positive trials were treated at hospitals with complex, efficient, resource-rich, team-based stroke systems in place. To ensure attainment of trial results in actual practice, patients should receive treatment at facilities certified as having the resources, personnel, organization, and continuous quality improvement..View full abstract
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Dr Mocco serves as a consultant to Reverse Medical, Lazarus Effect, Pulsar, Medina Medical, and Edge Therapeutics. Dr. Mocco has investor interests in Blockade Medical and Medina Medical. He is on the Advisory Board for Codman Neurovascular. Dr Fargen reports no disclosures. Dr Goyal is a consultant for Covidien and provided help with design and conduct of the SWIFT PRIME study. Covidien also provided partial funding to the ESCAPE trial to the University of Calgary. Dr Levy has shareholder/ownership interests in Intratech Medical Ltd. and Blockade Medical LLC. He is the National PI for Covidien - SWIFT Prime Trials and performs Carotid Training Sessions with Abbott - for physicians. He renders medical/legal opinion as an expert witness. Dr Mitchell serves as Co-PI of the EXTEND-IA trial. Dr Campbell serves as Co-PI of the EXTEND-IA trial. Dr Majoie serves as a consultant/speakers bureau for Stryker, with lecture fees paid to institution. Dr Dippel serves as a consultant/speakers bureau for Stryker, Medtronics and TEVA, with lecture fees paid to institution. Dr Khatri's Department of Neurology received financial support for her research roles from Genentech (PRISMS Trial Primary Investigator), Penumbra (Therapy Trial Neurology Primary Investigator) and Biogen (DSMB member). She also receives honoraria from UpToDate, Inc. Dr Hill is an employee of the University of Calgary. Grants to the University of Calgary from Covidien provided partial funding for the ESCAPE trial. Hoffmann-La Roche Canada Ltd provided drug as a grant-in-kind for the TEMPO-1 trial. Dr. Hill serves as an outcomes adjudicator for several clinical trials for Merck and receives modest compensation for this work. Dr. Hill has an ownership position (stock) in Calgary Scientific Inc., a medical imaging software company.Dr Saver is an employee of the University of California. The University of California, Regents, receive funding for Dr Saver's services as a scientific consultant regarding trial design and conduct to Covidien, Stryker, BrainsGate, Pfizer, Boehringer Ingelheim (prevention studies only), and St. Jude Medical. Dr Saver has served as an unpaid site investigator in multicenter trials run by Lundbeck for which the UC Regents received payments on the basis of clinical trial contracts for the number of subjects enrolled. Dr. Saver serves as an unpaid consultant to Genentech advising on the design and conduct of the PRISMS trial; neither the University of California nor Dr. Saver received any payments for this voluntary service. The University of California has patent rights in retrieval devices for stroke.