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A

BSUH Journal Club


Learning objectives

  • Recognise
  • Preventing
  • Management

Journal Club papers to be discussed 12/10/18

TitleAuthorsMethodsOutcomeComments
Mechanical Thrombectomy Outcomes With or Without Intravenous Thrombolysis Insight From the ASTER Randomized Trial ASTER Trial Investigators Post hoc analysis of the ASTER trial. The primary outcome was favorable 90-day functional outcome defined as a mRS of ≤2. Secondary outcomes were successful reperfusion following all procedures and after the first-line procedure, number of device passes, and change in National Institutes of Health Stroke Scale score at 24 hours. Safety outcomes included 90-day mortality and any symptomatic intracerebral hemorrhage. 381 pts, 250 IVT before MT (IVT+MT group). No significant differences between IVT+MT and MT-alone groups in 90-day favorable functional outcome or TICI score or NIHSS at 24h. The 90-day mortality rate in the IVT+MT group was lower than after MT alone. In a subgroup of patients without anticoagulant medication before stroke onset, we observed in the IVT+MT group a better functional outcome (fully-adjusted risk ratio, 1.38; 95% CI, 1.02–1.89), a higher successful recanalization rate after first-line strategy (fully-adjusted risk ratio, 1.26; 95% CI, 1.05–1.50), and a lower mortality rate (fully-adjusted risk ratio, 0.58. Conclusions—Our results show that IVT+MT patients in the ASTER trial have lower 90-day mortality compared with those receiving MT alone. In a selected population of patients without prestroke anticoagulation, we demonstrated that IVT associated with MT might improve functional outcome and recanalization while reducing mortality rates 95% CI, 0.36–0.93). Helps answer the question on IVT or not with MT. Trial demonstrates that IVT+MT patients in the ASTER trial have lower 90-day mortality compared with those receiving MT alone potentially associated with a selection bias (age and comorbidities).

References and further reading


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