title: Endovascular revascularization results in IMS III: intracranial ICA and M1 occlusions.
abstract: BACKGROUND
  Interventional Management of Stroke III did not show that combining IV recombinant tissue plasminogen activator (rt-PA) with endovascular therapies (EVTs) is better than IV rt-PA alone.
  
  
  OBJECTIVE
  To report efficacy and safety results for EVT of intracranial internal carotid artery (ICA) and middle cerebral artery trunk (M1) occlusion.
  
  
  METHODS
  Five revascularization methods for persistent occlusions after IV rt-PA treatment were evaluated for prespecified primary and secondary endpoints, after accounting for differences in key baselines variables using propensity scores. Revascularization was scored using the arterial occlusive lesion (AOL) and the modified Thrombolysis in Cerebral Ischemia (mTICI) scores.
  
  
  RESULTS
  EVT of 200 subjects with intracranial ICA or M1 occlusion resulted in 81.5% AOL 2-3 recanalization, in addition to 76% mTICI 2-3 and 42.5% mTICI 2b-3 reperfusion. Adverse events included symptomatic intracranial hemorrhage (SICH) (8.0%), vessel perforations (1.5%), and new emboli (14.9%). EVT techniques used were standard microcatheter n=51; EKOS n=14; Merci n=77; Penumbra n=39; Solitaire n=4; multiple n=15. Good clinical outcome was associated with both TICI 2-3 and TICI 2b-3 reperfusion. Neither modified Rankin scale (mRS) 0-2 (28.5%), nor 90-day mortality (28.5%), nor asymptomatic ICH (36.0%) differed among revascularization methods after propensity score adjustment for subjects with intracranial ICA or M1 occlusion.
  
  
  CONCLUSIONS
  Good clinical outcome was associated with good reperfusion for ICA and M1 occlusion. No significant differences in efficacy or safety among revascularization methods were demonstrated after adjustment. Lack of high-quality reperfusion, adverse events, and prolonged time to treatment contributed to lower-than-expected mRS 0-2 outcomes and study futility compared with IV rt-PA.
  
  
  BACKGROUND
  NCT00359424.
authors.affiliation: Department of Radiology, University of Cincinnati Academic Health Center, University Hospital 234 Goodman St, Cincinnati, Ohio, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Tomsick
authors.affiliation: Department of Radiology, University of Cincinnati Academic Health Center, University Hospital 234 Goodman St, Cincinnati, Ohio, USA.
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Yeatts
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: UCLA Stroke Center, 924 Westwood Blvd, Los Angeles, California, USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Carrozzella
authors.affiliation: Department of Radiology, University of Cincinnati Academic Health Center, University Hospital 234 Goodman St, Cincinnati, Ohio, USA.
authors.forename: Lydia
authors.initials: L
authors.lastname: Foster
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
authors.affiliation: Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Ruediger
authors.initials: R
authors.lastname: von Kummer
authors.affiliation: Department of Neuroradiology, Dresden University Stroke Center, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Rm 1242A, Foothills Hospital, Calgary, Alberta, Canada.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
authors.affiliation: The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Bernard
authors.initials: B
authors.lastname: Yan
authors.affiliation: Division of Neurosciences, Comprehensive Stroke Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
authors.affiliation: Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin, USA.
authors.forename: Wouter
authors.initials: W
authors.lastname: Schonewille
authors.affiliation: St Antonius Hospital Nieuwegein, Koekoekslaan 1, Nieuwegein 3435 CM 53226, Netherlands.
authors.forename: Stefan
authors.initials: S
authors.lastname: Engelter
authors.affiliation: University Hospital Basel, Petersgraben 4, Basel, Switzerland.
authors.forename: Renee
authors.initials: R
authors.lastname: Martin
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.affiliation: Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Spilker
authors.affiliation: Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA.
authors.forename: Yuko Y
authors.initials: YY
authors.lastname: Palesch
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000473:pathology; D002539:Cerebral Arterial Diseases / Q000188:drug therapy / Q000601:surgery*; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods*; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D017063:Outcome Assessment, Health Care; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Device; Intervention; Stroke; Thrombectomy; Thrombolysis