Evolution of Practice During the Interventional Management of Stroke III Trial and Implications for Ongoing Trials

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; Ruediger von Kummer; Carlos A. Molina; Mayank Goyal; Mikael Mazighi; Wouter J. Schonewille; Stefan T. Engelter; Craig Anderson; Judith Spilker; Janice Carrozzella; L. Scott Janis; Lydia D. Foster; Thomas A. Tomsick; Interventional Management Stroke I

doi:10.1161/STROKEAHA.114.005952

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Evolution of Practice During the Interventional Management of Stroke III Trial and Implications for Ongoing Trials

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Evolution of Practice During the Interventional Management of Stroke III Trial and Implications for Ongoing Trials

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, Ruediger von Kummer, …

Stroke (1970), Vol.45(12), pp.3606-3611

12/2014

DOI: 10.1161/STROKEAHA.114.005952

PMID: 25325911

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Abstract

Background and Purpose-We explored changes in the patient population and practice of endovascular therapy during the course of the Interventional Management of Stroke (IMS) III Trial. Methods-Changes in baseline characteristics, use of baseline CT angiography, treatment times and specifics, and outcomes were compared between the first 4 protocols and the fifth and final protocol. Results-Compared with subjects treated in the first 4 protocol versions (n=610), subjects treated in fifth and final protocol (n=46) were older (75 versus 68 years, P<0.0002) and less likely to have a pretreatment Rankin of 0 (76% versus 89%, P=0.01), were more likely to have a pretreatment CT angiography (65% versus 45%, P=0.009), had quicker median times in the endovascular arm from onset to start of intra-arterial therapy (209 versus 250 minutes, P=0.002) and to reperfusion (269 versus 344 minutes, P<0.0001), had a higher mean dose of total tissue-type plasminogen activator in the endovascular arm (74.0 versus 63.7 mg, P<0.0001), and were less likely to receive intra-arterial tissue-type plasminogen activator as part of the endovascular procedure (16% versus 44%, P=0.015). There were no significant differences in functional and safety outcomes between subjects treated in the 2 treatments arms in either the first 4 protocols or fifth protocol although the small sample size in the fifth protocol provided limited power. Conclusions-Endovascular technology and diagnostic approaches to acute stroke patients changed substantially during the IMS III Trial. Efforts to decrease the time to delivery of endovascular therapy were successful.

Cardiovascular System & Cardiology

Clinical Neurology

Life Sciences & Biomedicine

Neurosciences & Neurology

Peripheral Vascular Disease

Science & Technology

Details

Title: Subtitle: Evolution of Practice During the Interventional Management of Stroke III Trial and Implications for Ongoing Trials
Creators: Joseph P. Broderick - University of Cincinnati
Yuko Y. Palesch - Med Univ S Carolina, Dept Publ Hlth Sci, Charleston, SC USA
Andrew M. Demchuk - Univ Calgary, Seaman Family MR Res Ctr, Calgary Stroke Program, Dept Clin Neurosci,Hotchkiss Brain Inst, Calgary, AB, Canada
Sharon D. Yeatts - Medical University of South Carolina
Pooja Khatri - University of Cincinnati
Michael D. Hill - University of Calgary
Edward C. Jauch - Mountain Area Health Education Center
Tudor G. Jovin - Cooper University Hospital
Bernard Yan - Medical University of South Carolina
Ruediger von Kummer - Dresden Univ, Dept Neuroradiol, Stroke Ctr, Univ Hosp, Dresden, Germany
Carlos A. Molina - Hosp Univ Vall dHebron, Dept Neurol, Neurovasc Unit, Barcelona, Spain
Mayank Goyal - University of Calgary
Mikael Mazighi - University of Cincinnati Medical Center
Wouter J. Schonewille - Univ Med Ctr Utrecht, Dept Neurol, Utrecht, Netherlands
Stefan T. Engelter - University of Cincinnati Medical Center
Craig Anderson - Univ Sydney, Royal Prince Alfred Hosp, George Inst Global Hlth, Sydney, NSW 2006, Australia
Judith Spilker - Univ Cincinnati, Acad Hlth Ctr, Neurosci Inst, Dept Neurol & Rehabil Med, Cincinnati, OH 45267 USA
Janice Carrozzella - Univ Cincinnati, Acad Hlth Ctr, Neurosci Inst, Dept Neurol & Rehabil Med, Cincinnati, OH 45267 USA
L. Scott Janis - University of Cincinnati Medical Center
Lydia D. Foster - Med Univ S Carolina, Dept Publ Hlth Sci, Charleston, SC USA
Thomas A. Tomsick - Univ Cincinnati, Acad Hlth Ctr, Neurosci Inst, Dept Neurol & Rehabil Med, Cincinnati, OH 45267 USA
Interventional Management Stroke I
Resource Type: Journal article
Publication Details: Stroke (1970), Vol.45(12), pp.3606-3611
DOI: 10.1161/STROKEAHA.114.005952
PMID: 25325911
NLM abbreviation: Stroke
ISSN: 0039-2499
eISSN: 1524-4628
Publisher: Lippincott Williams & Wilkins
Number of pages: 10
Grant note: R01 NS039160; U01NS052220; U01NS054630; U01 NS054630; U01NS077304; U01 NS077304; U01 NS052220 / NINDS NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) 201300690 / Alberta Innovates U01NS077304 / NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS)
Language: English
Date published: 12/2014
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984020617902771

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