Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke
Joseph P Broderick, Yuko Y Palesch, Andrew M Demchuk, Sharon D Yeatts, Pooja Khatri, Michael D Hill, Edward C Jauch, Tudor G Jovin, Bernard Yan, Frank L Silver, Ruediger von Kummer, Carlos A Molina, Bart M Demaerschalk, Ronald Budzik, Wayne M Clark, Osama O Zaidat, Tim W Malisch, Mayank Goyal, Wouter J Schonewille, Mikael Mazighi Show all
NEW ENGLAND JOURNAL OF MEDICINE | MASSACHUSETTS MEDICAL SOC | Published : 2013
BACKGROUND: Endovascular therapy is increasingly used after the administration of intravenous tissue plasminogen activator (t-PA) for patients with moderate-to-severe acute ischemic stroke, but whether a combined approach is more effective than intravenous t-PA alone is uncertain. METHODS: We randomly assigned eligible patients who had received intravenous t-PA within 3 hours after symptom onset to receive additional endovascular therapy or intravenous t-PA alone, in a 2:1 ratio. The primary outcome measure was a modified Rankin scale score of 2 or less (indicating functional independence) at 90 days (scores range from 0 to 6, with higher scores indicating greater disability). RESULTS: The s..View full abstract
Awarded by National Institute of Neurological Disorders and Stroke
Awarded by NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00359424.)Supported by grants from the National Institutes of Health and the National Institute of Neurological Disorders and Stroke (UC U01NS052220, MUSC U01NS054630, and U01NS077304) and by Genentech, EKOS, Concentric Medical, Cordis Neurovascular, and Boehringer Ingelheim.Dr. Broderick reports receiving consulting fees from Photo-Thera, receiving lecture fees from Oakstone Publishing, and receiving a drug from Schering-Plough for use in a study funded by the National Institutes of Health. Dr. Palesch reports receiving consulting fees from BrainsGate and Edge Therapeutics. Dr. Demchuk reports receiving grant support and lecture fees from Covidien. Dr. Khatri reports receiving consulting fees from Penumbra, Genentech, and Janssen Pharmaceuticals; providing expert testimony for Medico-Legal Consulting; receiving lecture fees from Medical Dialogues; receiving royalties from Informa, and receiving travel support from Genentech. Dr. Hill reports receiving consulting fees from Vernalis Group; receiving grant support from Hoffmann-La Roche Canada; receiving lecture fees from Hoffmann-La Roche Canada, Servier Canada, and Bristol-Myers Squibb Canada; receiving stock options from Calgary Scientific; receiving support from the Heart and Stroke Foundation of Alberta, Northwest Territories, and Nunavut and Alberta Innovates-Health Solutions; and serving as an unpaid board member for the Heart and Stroke Foundation of Alberta, Northwest Territories, and Nunavut and the Institute of Circulatory and Respiratory Health of the Canadian Institutes of Health Research. Dr. Jovin reports receiving consulting fees and stock options from Silk Road Medical. Dr. Silver reports serving as an unpaid board member for Boehringer Ingelheim Canada, Bayer Canada, and Bristol-Myers Squibb and Pfizer Canada; receiving lecture fees from Boehringer Ingelheim Canada and Servier Canada; and receiving travel support from Boehringer Ingelheim Canada. Dr. von Kummer reports serving as a board member for Lundbeck and Boehringer Ingelheim; receiving consulting fees from Lundbeck; and receiving lecture fees from Penumbra, Boehringer Ingelheim, and Lundbeck. Dr. Demaerschalk reports receiving grant support and consultant fees from Genentech. Dr. Budzik reports receiving consulting and lecture fees from Concentric Medical. Dr. Goyal reports receiving consulting and lecture fees from Covidien; receiving grant support from Covidien; and owning stock options in Calgary Scientific and NoNO. Dr. Engelter reports serving as a board member for Boehringer Ingelheim and receiving travel support from Boehringer Ingelheim. Dr. Anderson reports receiving lecture fees and travel support from GE Healthcare. Ms. Spilker reports receiving payment for the development of educational presentations from The Stroke Group and serving as a board member for The Stroke Interventionalist: The Clinical Journal of Acute Stroke Treatment. Dr. Tomsick reports receiving grant support from Covidien. No other potential conflict of interest relevant to this article was reported.