The first hints of a rollback in tPA use are starting to emerge – not unexpectedly, from those working to improve the outcomes of their endovascular programs.
This is a retrospective evaluation of patients from Bern, Switzerland, all treated with endovascular therapy. Their registry includes 372 patients since 2004, all treated for MCA or ICA occlusions and with DWI measurements pre-treatment. As with any data dredge, any findings are just hypotheticals – but, there’s a couple interesting tidbits:
- Smaller lesions did much, much better – 54.5% achieved mRS 0-2 if lesion volume was <70mL, compared with 21.2% with lesion volume >70mL.
- If you failed to reperfuse a lesion volume >70mL, mRS 0-2 outcomes sank to 8.6%.
- Symptomatic intracranial hemorrhage jumped to 19.7% for lesion volume >70mL.
- There were only 66 patients over >70mL lesion volume, but the best outcomes? The 19 with mechanical therapy only – balancing 21.1% mRS 0-2 with only 5.3% SICH.
The authors ultimately conclude endovascular therapy for large lesion volumes might be best without any thrombolytic involved.
Wasn’t it lovely how fashionable tPA was – until endovascular therapy finally reached a tipping point in terms of efficacy?
“Younger Stroke Patients With Large Pretreatment Diffusion-Weighted Imaging Lesions May Benefit From Endovascular Treatment”
http://stroke.ahajournals.org/content/early/2015/08/06/STROKEAHA.115.010250.short