MD Conference Express ISC 2012 - (Page 15)
Cumulative Probablility of a Primary Endpoint
Baseline measures of risk factors between the two groups were similar, except that glycated hemoglobin in diabetics was lower in the antithrombotic therapy group (p=0.03). In terms of concomitant medication at the time of study entry, only beta-blockers and nonstatin lipid-lowering medications were different between the group-on (119/284, 42%; 58/284, 20%) and group-off (53/167, 32%; 19/167, 11%) participants (p=0.0319 and p=0.0137, respectively). The percentage of group-on patients who were on AMM (n=140) who reached the primary endpoint was 12.1%; in the PTAS group (n=144), the primary endpoint was reached by 21.5% of patients. At 30 days, the primary endpoint rates were 4.3% versus 16.0%, respectively; after 30 days, they were 7.9% versus 5.6%, respectively. Among those who were on antithrombotic therapy with a qualifying event, the cumulative probability of a primary endpoint occurring at 15 months of follow-up was significantly higher in the PTAS group than the AMM group (p=0.028 overall; p=0.0009 at 30 days; Figure 1). Among those who were on antithrombotic therapy and had a history of ischemic stroke with a qualifying event, the difference in the primary endpoint between the AMM (n=49) and PTAS group (n=51) was 14.3% versus 35.3%, respectively. At 30 days, the respective numbers were 8.2% versus 25.5%, and after 30 days, they were 6.1% versus 9.8% (p=0.014 overall; p=0.019 at 30 days). Figure 1. Qualifying Event On Antithrombotic Therapy.
PTAS 0.20
Figure 2. Qualifying Event Not On Antithrombotic Therapy.
0.20 AMM
0.15 PTAS 0.10
0.05 Overall: p=0.14 At 30 Days: p=0.35 0 0 3 6 9 Months After Randomization
60 57 48 47
12
15
No. At Risk AMM PTAS
87 80
73 68
43 29
38 23
Reproduced with permission from HL Lutsep.
The authors pointed out that those patients who had been on antithrombotics had a greater number of risk factors and that those patients with intracranial stenosis had more benefit from AMM than PTAS with the Wingspan stent system, even if they had failed antithrombotic therapy. The benefit of AMM is similar in patients who are on versus off antithrombotic medication at the time of their qualifying events. These findings support those from the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) trial, showing that antithrombotic therapy failure does not identify a higher-risk subgroup of patients with intracranial stenosis [Chimowitz MI et al. N Engl J Med 2005].
Cumulative Probablility of a Primary Endpoint
0.15
AMM
0.10
Initial Clinical Results with TREVO® Mechanical Thrombectomy Device are Promising
Written by Rita Buckley
12 15
0.05 Overall: p=0.028 At 30 Days: p=0.0009 0 0 3 6 9 Months After Randomization
105 96 84 78
No. At Risk AMM PTAS
140 144
124 114
72 69
55 60
Reproduced with permission from HL Lutsep.
There was no significant difference between the AMM and PTAS groups that had a qualifying event while not on antithrombotic therapy (p=0.14 overall; p=0.35 at 30 days; Figure 2). No significant difference was observed between those patients who were treated with AMM who were either on or off antithrombotics at the time of their qualifying event.
Experimental data suggest that the novel Trevo device is highly effective at achieving immediate reperfusion of occluded arteries without causing any clinically significant disruption of vascular integrity [Nogueira RG et al. J Neurointerv Surg 2011]. Nils Wahlgren, MD, PhD, Karolinska Institutet, Stockholm, Sweden, also reported promising findings from the Phase 4 Thrombectomy REvascularization of Large Vessel Occlusions in Acute Ischemic Stroke trial [TREVO; NCT01088672]. This multicenter, international, prospective, single-arm clinical trial included 60 patients at 7 sites in Germany,
Highlights from the International Stroke Conference 2012
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Table of Contents for the Digital Edition of MD Conference Express ISC 2012
MD Conference Express ISC 2012
From Neurovascular Laboratory to Clinic: A Journey Through Time
No Compelling Evidence to Use Warfarin or Aspirin in Heart Failure Patients
AXIS 2 Clinical Outcomes No Different Than Placebo
SAMMPRIS: 30-Day Outcomes After Angioplasty and Stenting
Aggressive Medical Therapy Benefits Those Who Fail Antithrombotic Therapy
Initial Clinical Results with TREVO® Mechanical Thrombectomy Device are Promising
Linking sICH Definitions to Outcomes
Solitaire™ Flow Restoration Device Achieves Successful Recanalization Free of Symptomatic Hemorrhage Transformation
FIA II Seeks Genetic Underpinnings of Familial Intracranial Aneurysm
SPS3 Study Does Not Support the Use of Combination Therapy for Stroke Prevention
Novel Agent NA-1 Proves that Ischemic Neuroprotection is Possible in Older Patients
Acute Endovascular Treatment
Neuroimaging
Stroke Guidelines: Current Recommendations in Principle and Practice
The Rising Trend of Ischemic Stroke in the Young
Advanced Neuroimaging Adds Time, Reduces Endovascular Treatment in Clinical Practice
MD Conference Express ISC 2012
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