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Abstract 186: Effectiveness of Endovascular Recanalization for Acute Stroke: A Transition Toward Superiority Over Intravenous Thrombolysis


 Background:
 There is skepticism in clinical practice about the comparative effectiveness of endovascular recanalization compared to intravenous thrombolysis for acute ischemic stroke, and there is a paucity of information about effectiveness and safety trends.
 
 
 Methods:
 We identified 872 acute ischemic stroke patients who underwent recanalization therapy with intravenous thrombolysis only (IVT; n=533) or endovascular recanalization with or without intravenous thrombolysis (EVT; n=339) from a prospective, multicenter stroke registry database between April 2008 and January 2012. All study subjects had NIHSS score ≥10 and arrived within 4.5 hours of onset. Inverse probability of EVT weighting by propensity score was used to remove baseline imbalance between treatment groups. Primary outcome was mRS score 0 – 2 at the time of discharge. Year-by-year effectiveness and safety of EVT over IVT were estimated with further adjustment by age, NIHSS score, onset to arrival time, duration of hospitalization and treatment year.
 
 
 Results:
 Before 2010, the primary outcome was not associated with treatment modality. However in 2011, EVT increased the odds of better primary outcome compared to IVT (adjusted OR, 1.87; 95% CI, 1.08 – 3.23). Also in year 2011, EVT became superior to IVT for mRS score 0 – 2 (1.99; 1.10 – 3.59) at 3 months after stroke. The odds of mortality during admission and at 3 month and symptomatic hemorrhagic transformation were not different between recanalization methods throughout the study period (see Figure). Subgroup analyses showed that effect estimates from EVT were significantly modified by total stroke volume of hospital (higher in ≥30 stroke cases per month) and time from onset to arrival (higher in ≥2-hour delay).
 
 
 
 
 
 Conclusion:
 Over time, endovascular recanalization has become superior to intravenous thrombolysis for improvement of clinical outcomes in acute ischemic stroke.
