title: Endovascular interventions following intravenous thrombolysis may improve survival and recovery in patients with acute ischemic stroke: a case-control study.
abstract: OBJECTIVE
  Since the introduction of recombinant tissue plasminogen activator (rtPA) into clinical practice in the mid 1990s, no adjunctive treatment has further improved clinical outcomes in patients with ischemic stroke. The safety, feasibility, and efficacy of combining intravenous (IV) rtPA with endovascular interventions has been described; however, no direct comparative study has yet established whether endovascular interventions after IV rtPA are superior to IV rtPA alone. A retrospective case-control study was designed to address this issue.
  
  
  METHODS
  Between 2003 and 2006, 33 consecutive patients with acute ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) scores >/=10 were treated with IV rtPA in combination with endovascular interventions (IV plus intervention) at a tertiary care facility. Outcomes were compared with a control cohort of 30 consecutive patients treated with IV rtPA (IV only) at a comparable facility where endovascular interventions were not available.
  
  
  RESULTS
  Baseline parameters were similar between the 2 groups. We found that the IV-plus-intervention group experienced significantly lower mortality at 90 days (12.1% versus 40.0%, P = .019) with a significantly greater improvement in NIHSS scores by the time of discharge or follow-up (P = .025). In the IV-plus-intervention group, patients with admission NIHSS scores between 10 and 15 and patients </=80 years of age showed the greatest improvement, with a significant change of the NIHSS scores from admission (P = .00015 and P = .013, respectively).
  
  
  CONCLUSIONS
  In this small case-control study of patients with acute ischemic stroke and admission NIHSS scores >/=10, there was a suggestion of incremental clinical benefit among patients receiving endovascular interventions following standard administration of IV rtPA.
authors.affiliation: Zeenat Quereshi Stroke Research Center, University of Minnesota, Minneapolis, Minn, USA.
authors.forename: T C
authors.initials: TC
authors.lastname: Burns
authors.forename: G J
authors.initials: GJ
authors.lastname: Rodriguez
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.forename: H M
authors.initials: HM
authors.lastname: Hussein
authors.forename: A L
authors.initials: AL
authors.lastname: Georgiadis
authors.forename: K
authors.initials: K
authors.lastname: Lakshminarayan
authors.forename: A I
authors.initials: AI
authors.lastname: Qureshi
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000401:mortality* / Q000628:therapy*; D016022:Case-Control Studies; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D004621:Embolization, Therapeutic / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D011994:Recombinant Proteins / Q000008:administration & dosage; D020127:Recovery of Function; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000401:mortality / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
references.citation: Arch Phys Med Rehabil. 2005 Nov;86(11):2081-6
references.pmid: 16271552
references.citation: J Vasc Interv Radiol. 2002 Dec;13(12):1269-74
references.pmid: 12471193
references.citation: J Neuroimaging. 2007 Apr;17(2):124-30
references.pmid: 17441833
references.citation: AJNR Am J Neuroradiol. 2008 Feb;29(2):253-8
references.pmid: 18024576
references.citation: Neurology. 2005 Jan 25;64(2):386-8
references.pmid: 15668451
references.citation: J Neuroimaging. 2004 Jul;14(3):235-41
references.pmid: 15228764
references.citation: Stroke. 2007 Jul;38(7):2127-35
references.pmid: 17525387
references.citation: Neurosurgery. 2007 Apr;60(4):701-6; discussion 706
references.pmid: 17325617
references.citation: JAMA. 1999 Dec 1;282(21):2003-11
references.pmid: 10591382
references.citation: Neurosurgery. 2002 Jun;50(6):1405-14; discussion 1414-5
references.pmid: 12015866
references.citation: Neurosurgery. 2002 Feb;50(2):251-9; discussion 259-60
references.pmid: 11844259
references.citation: Stroke. 2004 Apr;35(4):904-11
references.pmid: 15017018
references.citation: Stroke. 1999 Dec;30(12):2598-605
references.pmid: 10582984
references.citation: Stroke. 2004 Dec;35(12):2848-54
references.pmid: 15514171
references.citation: Stroke. 2005 Nov;36(11):2421-5
references.pmid: 16210554
references.citation: Stroke. 1996 Sep;27(9):1711-8
references.pmid: 8784157
references.citation: Stroke. 2002 Mar;33(3):717-24
references.pmid: 11872894
references.citation: Stroke. 2006 Jul;37(7):1805-9
references.pmid: 16763175
references.citation: Neuroradiology. 2008 Apr;50(4):331-40
references.pmid: 18172631
references.citation: Stroke. 2007 Apr;38(4):1274-80
references.pmid: 17332445
references.citation: AJNR Am J Neuroradiol. 1994 Nov;15(10):1817-22
references.pmid: 7863929
references.citation: Stroke. 2006 Mar;37(3):922-8
references.pmid: 16439705
references.citation: Neurosurgery. 2001 Jul;49(1):41-8; discussion 48-50
references.pmid: 11440458
references.citation: Stroke. 2007 Jan;38(1):80-4
references.pmid: 17122433
references.citation: Stroke. 2005 Jul;36(7):1432-8
references.pmid: 15961709
references.citation: Neurology. 2007 Jan 2;68(1):39-44
references.pmid: 17200490
references.citation: Neurocrit Care. 2007;7(1):53-7
references.pmid: 17657656
references.citation: Clin Privil White Pap. 2004 Dec;(225):1-8
references.pmid: 15570691
references.citation: Stroke. 1998 Jan;29(1):4-11
references.pmid: 9445320
references.citation: Neurology. 2007 Jun 12;68(24):2132-9
references.pmid: 17562835
references.citation: N Engl J Med. 1995 Dec 14;333(24):1581-7
references.pmid: 7477192
references.citation: J Neuroimaging. 2008 Jul;18(3):262-7
references.pmid: 18422516