EXTEND-IA
Trial question
Is endovascular therapy superior to alteplase in patients with ischemic stroke?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
51.0% female
49.0% male
N = 70
70 patients (36 female, 34 male).
Inclusion criteria: patients with a proximal cerebral arterial occlusion and salvageable tissue on CT perfusion imaging who were receiving alteplase.
Key exclusion criteria: pregnancy; ICH; mRS score ≥ 2; rapidly improving symptoms; previous stroke within last 3 months; life expectancy < 1 year; current use of OACs.
Interventions
N=35 endovascular therapy (endovascular thrombectomy with solitaire flow restoration stent retriever).
N=35 alteplase only (continuation of alteplase alone at a dose of 0.9 mg/kg).
Primary outcome
Successful reperfusion at 24 hours
100%
37%
100.0 %
75.0 %
50.0 %
25.0 %
0.0 %
Endovascular
therapy
Alteplase
only
Significant
increase ▲
NNT = 1
Significant increase in successful reperfusion at 24 hours (100% vs. 37%; OR 4.7, 95% CI 2.5 to 9).
Secondary outcomes
Significant increase in early neurologic improvement at day 3 (80% vs. 37%; OR 6, 95% CI 2 to 18).
Significantly lower reduction in mRS score at day 90 (1 points vs. 3 points; OR 0.48, 95% CI 0.26 to 0.83).
Significant increase in patients achieving a modified Randkin scale score of 0-2 at day 90 (71% vs. 40%; OR 4.2, 95% CI 1.4 to 12).
Safety outcomes
No significant differences in death, sympatomatic intracerebral hemorrhage, parenchymal hematoma.
Conclusion
In patients with a proximal cerebral arterial occlusion and salvageable tissue on CT perfusion imaging who were receiving alteplase, endovascular therapy was superior to alteplase only with respect to successful reperfusion at 24 hours.
Reference
Bruce C V Campbell, Peter J Mitchell, Timothy J Kleinig et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015 Mar 12;372(11):1009-18.
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