Future acute ischemic stroke trials should randomize on the angio table

Perhaps in order to move forward we need to take a lesson from the past. The only two positive randomized trials of intra-arterial therapy to date are PROACT II and MELT.1 2 In both of those cases, randomization occurred on the table, after angiographic confirmation of proximal vessel occlusion. Of patients in PROACT II randomized to a saline infusion, 25% had a good functional outcome (modified Rankin Scale 0–2) at 90 days, compared with 40% of those who received a urokinase infusion. Similarly, in MELT, 23% randomized to saline infusion had modified Rankin Scale 0–1 at 90 days compared with 42% of those with urokinase infusion. Both these differences were statistically significant, with a total of just 294 patients randomized in both trials We have better tools now. Our Thrombolysis in Cerebral Infarction (TICI) 2b/3 recanalization rates with modern stentriever and aspiration technology approach 90%,3–5
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: Editorials Source Type: research