Trials Demonstrate Benefits of Endovascular Stroke Therapy in “Resounding Fashion,” NEJM Editorial States

Anthony J. Furlan, M.D., Chairman of Neurology and Co-Director of the Neurological Institute at University Hospitals (UH) Case Medical Center and Case Western Reserve University School of Medicine, who writes an accompanying editorial for five studies about endovascular stroke therapy published simultaneously on April 17, 2015 in the New England Journal of Medicine, says these randomized clinical trials represent a breakthrough in showing the benefits of endovascular therapy for acute ischemic strokes. "Now even endovascular skeptics will be convinced," Dr. Furlan writes. His editorial, entitled “Endovascular Stroke Therapy: It's About Time,” states that these trials demonstrate the therapy is highly beneficial in a "resounding fashion." The studies compared endovascular therapy - administration of an intravenous clot-busting agent (tPA) followed by device removal of a clot blocking a brain artery - with the clot-busting agent IV tPA alone for the treatment of ischemic stroke. Dr. Furlan says that these new studies should settle any lingering uncertainties that have existed over endovascular therapy (also known as intra-arterial therapy), especially since three studies in 2013 indicated the therapy was no more effective than IV tPA alone. He attributes the difference in results in the new studies to three factors: superior surgical technology resulting in faster, more complete clearage of the blockage; heightened awareness of decreasing the amount of time between patient arrival in the emergency department to the start of the endovascular procedure, and improved neuroimaging criteria for selecting patients most likely to benefit from the therapy. Dr. Furlan says these studies represent a paradigm shift reminiscent of the introduction of the clot-busting therapy IV tPA in the 1990s.
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