Acute Intra-Arterial Treatment Effective in Extracranial Carotid Disease

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Researchers conducted a prespecified subgroup analysis of a randomized clinical trial of endovascular treatment at 16 hospitals in the Netherlands.
Researchers conducted a prespecified subgroup analysis of a randomized clinical trial of endovascular treatment at 16 hospitals in the Netherlands.

HealthDay News — Acute intra-arterial treatment (IAT) seems to be as effective for patients with acute ischemic stroke caused by intracranial proximal occlusion with, vs those without, extracranial carotid disease (ECD), according to research published online in the Annals of Internal Medicine.

Olvert A. Berkhemer, MD, PhD, from the Academic Medical Center in Amsterdam, and colleagues conducted a prespecified subgroup analysis of a randomized clinical trial of endovascular treatment for intracranial proximal anterior circulation occlusion in 16 hospitals in the Netherlands. Participants received either IAT or no IAT.

The researchers found that the functional outcome was associated with an adjusted common odds ratio (acOR) of 1.67 (95% Cl, 1.21-2.30) in favor of the intervention. In the prespecified subgroup of patients with ECD, the acOR was 3.1 (95% CI, 1.7-5.8), compared to 1.3 (95% CI, 0.9-1.9) in patients presenting without ECD (P for interaction =.07).

"Intra-arterial treatment may be at least as effective in patients with ECD as in those without ECD, and it should not be withheld in these complex patients with acute ischemic stroke," the authors wrote.

Disclosures: Several authors disclosed financial ties to biopharmaceutical companies, including AngioCare, Medtronic/Covidien/EV3, MEDAC/LAMEPRO, Penumbra, Stryker, and Top Medical/Concentric, all of which partially funded the study.

Reference

Berkhemer OA, Borst J, Kappelhof M, et al; on behalf of the MR CLEAN investigators. Extracranial carotid disease and effect of intra-arterial treatment in patients with proximal anterior circulation stroke in MR CLEAN [published May 23, 2017]. Ann Intern Med. doi:10.7326/M16-1536

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