(HealthDay)—Endovascular treatment (EVT) alone is neither superior nor noninferior to intravenous alteplase followed by EVT in a cohort of European patients with stroke, according to a study published in the Nov. 11 issue of the New England Journal of Medicine.
Natalie E. LeCouffe, M.D., from the University of Amsterdam, and colleagues performed an open-label, multicenter, randomized trial in Europe involving patients with stroke who presented directly to a hospital that was capable of providing EVT. Overall, 539 patients were randomly assigned to receive EVT alone or intravenous alteplase followed by EVT (standard of care) in a 1:1 ratio.
The researchers found that the median score on the modified Rankin scale at 90 days was 3 and 2 with EVT alone and alteplase plus EVT, respectively, for an adjusted common odds ratio of 0.84 (95 percent confidence interval [CI], 0.62 to 1.15; P = 0.28), which demonstrated neither superiority nor noninferiority of EVT alone. Mortality was 20.5 and 15.8 percent for EVT alone and alteplase plus EVT, respectively (adjusted odds ratio, 1.39; 95 percent CI, 0.84 to 2.30), and symptomatic intracerebral hemorrhage occurred in 5.9 and 5.3 percent, respectively (adjusted odds ratio, 1.30; 95 percent CI, 0.60 to 2.81).
“In contrast to some previous trials involving Asian patients with anterior-circulation stroke, we did not find that EVT alone was noninferior or superior to intravenous alteplase combined with EVT with regard to functional outcome at 90 days,” the authors write.
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