Efficacy of Stent-Retriever Thrombectomy in Magnetic Resonance Imaging Versus Computed Tomographic Perfusion–Selected Patients in SWIFT PRIME Trial (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke)

BACKGROUND AND PURPOSE—The majority of patients enrolled in SWIFT PRIME trial (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke) had computed tomographic perfusion (CTP) imaging before randomization; 34 patients were randomized after magnet...

Full description

Saved in:
Bibliographic Details
Published in:Stroke (1970) 2017-06, Vol.48 (6), p.1560-1566
Main Authors: Menjot de Champfleur, Nicolas, Saver, Jeffrey L, Goyal, Mayank, Jahan, Reza, Diener, Hans-Christoph, Bonafe, Alain, Levy, Elad I, Pereira, Vitor M, Cognard, Christophe, Yavagal, Dileep R, Albers, Gregory W
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Brain Ischemia - diagnostic imaging
Brain Ischemia - etiology
Brain Ischemia - therapy
Carotid Artery Diseases - complications
Cerebrovascular Circulation
Combined Modality Therapy
Diffusion Magnetic Resonance Imaging - methods
Female
Fibrinolytic Agents - therapeutic use
Humans
Infarction, Middle Cerebral Artery - complications
Life Sciences
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Single-Blind Method
Stents
Stroke - diagnostic imaging
Stroke - etiology
Stroke - therapy
Thrombectomy - methods
Time Factors
Tissue Plasminogen Activator - therapeutic use
Tomography, X-Ray Computed - methods
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:BACKGROUND AND PURPOSE—The majority of patients enrolled in SWIFT PRIME trial (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke) had computed tomographic perfusion (CTP) imaging before randomization; 34 patients were randomized after magnetic resonance imaging (MRI). METHODS—Patients with middle cerebral artery and distal carotid occlusions were randomized to treatment with tPA (tissue-type plasminogen activator) alone or tPA+stentriever thrombectomy. The primary outcome was the distribution of the modified Rankin scale score at 90 days. Patients with the target mismatch profile for enrollment were identified on MRI and CTP. RESULTS—MRI selection was performed in 34 patients; CTP in 139 patients. Baseline National Institutes of Health Stroke Scale score was 17 in both groups. Target mismatch profile was present in 95% (MRI) versus 83% (CTP). A higher percentage of the MRI group was transferred from an outside hospital (P=0.02), and therefore, the time from stroke onset to randomization was longer in the MRI group (P=0.003). Time from emergency room arrival to randomization did not differ in CTP versus MRI-selected patients. Baseline ischemic core volumes were similar in both groups. Reperfusion rates (>90%/TICI [Thrombolysis in Cerebral Infarction] score 3) did not differ in the stentriever-treated patients in the MRI versus CTP groups. The primary efficacy analysis (90-day mRS score) demonstrated a statistically significant benefit in both subgroups (MRI, P=0.02; CTP, P=0.01). Infarct growth was reduced in the stentriever-treated group in both MRI and CTP groups. CONCLUSIONS—Time to randomization was significantly longer in MRI-selected patients; however, site arrival to randomization times were not prolonged, and the benefits of endovascular therapy were similar. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01657461.
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.117.016669