MD Conference Express ISC 2012 - (Page 21)
female patients who were undergoing endovascular repair of a brain aneurysm to receive 2.6 mg/kg of NA-1 (n=92), a peptide designed to reduce ischemic brain damage, or placebo (n=93) as a 10-minute intravenous infusion after completion of the endovascular procedure on Day 1. The primary outcome measures were to determine the safety and tolerability of a single IV dose of NA-1 in patients who were undergoing endovascular repair of brain aneurysms and establish the efficacy of NA-1 in reducing the volume of embolic strokes on enrollment and Days 1, 2–4, and 30. Secondary outcome measures were to determine the efficacy of a single IV dose of NA-1 in reducing the number of embolic strokes, procedurally induced vascular cognitive impairment, and frequency of large strokes on enrollment and Days 1, 2–4, and 30. Other than the number of past smokers (26.9% in controls versus 43.8% in the treatment group), baseline characteristics and treatment factors were similar between the two groups. Except for 2 adverse events of transient (15 minutes) mild hypotension, no serious adverse events were attributable to NA-1. Compared with baseline, the number and volume reductions of diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) lesions in all subjects were significant (p=0.005 and p=0.026, respectively). In ruptured aneurysm patients, significant reductions in the number of DWI and FLAIR lesions were observed in the treatment and control groups (unadjusted p=0.027 and p=0.46, respectively); similarly, there were significant reductions in the volume of DWI and FLAIR lesions (unadjusted p=0.015 and p=0.023, respectively). In unruptured aneurysm subjects, there were significant reductions between the treatment and control groups in the number of DWI lesions (adjusted p=0.019). In patients without large stroke, there were significant reductions in the number of DWI and FLAIR lesions (adjusted p=0.002 and p=0.012, respectively) as well as in volume (p=0.009 and p=0.014, respectively). Among proportions of patients with DWI lesions, binned at the 90th percentile, more NA-1 subjects had 0 or 1 lesions; fewer had >15 lesions (p=0.012). Among subjects with ruptured aneurysms, 68.4% of controls and 100% of the treatment group had an NIHSS of 0 to 1 (p=0.020); 73.7% of controls and 94.4% of the treatment group had a modified Rankin scale score of 0 to 2. The relative risk was 1.3 (95% CI, 0.95 to 1.7; p=0.180). Overall, the trial showed that NA-1 was safe in patients with ruptured and unruptured aneurysms and reduced the
number and volume of ischemic stroke lesions in a human model of iatrogenic embolic stroke. The study implies that neuroprotection is possible in older patients and that multiple endovascular procedures may be amenable to NA-1 treatment for stroke. The authors concluded that testing of NA-1 in human community-acquired stroke is a priority and that it may be a useful treatment for ruptured aneurysm patients.
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The editors would like to thank the many members of the International Stroke Conference 2012 presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.
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
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