How to establish the outer limits of reperfusion therapy

Lawrence R Wechsler; Ashutosh P Jadhav; Tudor G Jovin; Opeolu Adeoye; Greg Albers; Saeed Ansari; Johannes Boltze; Alastair Buchan; Bruce C.V Campbell; Napasri Chaisinanunkul; Christopher Chen; Colin P Derdeyn; Walid Haddad; Michael D Hill; William Holt; Gary Houser; Pooja Khatri; Ana Krtolica; Jaren W Landen; Maarten G Lansberg; David S Liebeskind; Patrick Lyden; John Lynch; Caitlyn Meinzer; Eva A Mistry; J Mocco; Raul G Nogueira; Jeffrey L Saver; Sean I Savitz; Lee H Schwamm; Kevin N Sheth; Meredith Snyder; Yoram Solberg; Achala Vagal; Chitra Venkatasubramanian; Steven Warach; Nikolaos K Ziogas

doi:10.1161/STROKEAHA.121.035022

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How to establish the outer limits of reperfusion therapy

Journal article

Open access

How to establish the outer limits of reperfusion therapy

Lawrence R Wechsler, Ashutosh P Jadhav, Tudor G Jovin, Opeolu Adeoye, Greg Albers, Saeed Ansari, Johannes Boltze, Alastair Buchan, Bruce C.V Campbell, Napasri Chaisinanunkul, …

Stroke, Vol.52(10), pp.3399-3403

09/02/2021

DOI: 10.1161/STROKEAHA.121.035022

PMID: 34470484

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Abstract

Reperfusion therapy with intravenous alteplase and endovascular therapy are effective treatments for selected patients with acute ischemic stroke. Guidelines for treatment are based upon randomized trials demonstrating substantial treatment effects for highly selected patients based on time from stroke onset and imaging features. However, patients beyond the current established guidelines might benefit with lesser but still clinically significant treatment effects. The STAIR (Stroke Treatment Academic Industry Roundtable) XI meeting convened a workgroup to consider the “outer limits” of reperfusion therapy by defining the current boundaries, and exploring optimal parameters and methodology for determining the outer limits. In addition to statistical significance, the minimum clinically important difference should be considered in exploring the limits of reperfusion therapy. Societal factors and quality of life considerations should be incorporated into assessment of treatment efficacy. The threshold for perception of benefit in the medical community may differ from that necessary for the Food and Drug Administration approval. Data from alternative sources such as platform trials, registries and large pragmatic trials should supplement randomized controlled trials to improve generalizability to routine clinical practice. Further interactions between industry and academic centers should be encouraged.

RB Pathology

RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry

Details

Title: Subtitle: How to establish the outer limits of reperfusion therapy
Creators: Lawrence R Wechsler - University of Pennsylvania
Ashutosh P Jadhav - St. Joseph's Hospital and Medical Center
Tudor G Jovin - Cooper Medical School of Rowan University
Opeolu Adeoye
Greg Albers
Saeed Ansari
Johannes Boltze
Alastair Buchan
Bruce C.V Campbell
Napasri Chaisinanunkul
Christopher Chen
Colin P Derdeyn
Walid Haddad
Michael D Hill
William Holt
Gary Houser
Pooja Khatri
Ana Krtolica
Jaren W Landen
Maarten G Lansberg
David S Liebeskind
Patrick Lyden
John Lynch
Caitlyn Meinzer
Eva A Mistry
J Mocco
Raul G Nogueira
Jeffrey L Saver
Sean I Savitz
Lee H Schwamm
Kevin N Sheth
Meredith Snyder
Yoram Solberg
Achala Vagal
Chitra Venkatasubramanian
Steven Warach
Nikolaos K Ziogas
Resource Type: Journal article
Publication Details: Stroke, Vol.52(10), pp.3399-3403
DOI: 10.1161/STROKEAHA.121.035022
PMID: 34470484
NLM abbreviation: Stroke
ISSN: 0039-2499
eISSN: 1524-4628
Publisher: Lippincott Williams & Wilkins
Language: English
Date published: 09/02/2021
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984277552202771

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