(UPDATED) For patients with acute ischemic strokes caused by large-vessel occlusions, forgoing IV thrombolytics before mechanical thrombectomy may be a viable option, according to the results of two trials published online this week in
JAMA.
In the DEVT trial, taking patients directly to the cath lab resulted in noninferior 90-day functional outcomes compared with the guideline-recommended approach of administering IV alteplase before the intervention, lead author Wenjie Zi, MD (Xinqiao Hospital and The Second Affiliated Hospital, Chongqing, China), and colleagues report.
And in the SKIP trial, which was initially presented at the International Stroke Conference last year, functional outcomes were similar with the two strategies. The trial, however, did not establish the noninferiority of skipping IV thrombolytics, a result attributed to higher-than-expected rates of recanalization and favorable outcomes.
email article
Two small trials added to the evidence that some stroke patients could fare well going straight to mechanical thrombectomy without IV thrombolysis, though the studies were confined to Asian populations and non-inferiority was not shown in the strictest sense.
For patients with acute ischemic stroke due to large vessel occlusion, results were inconclusive (but somewhat favorable) for a strategy of skipping the IV tissue plasminogen activator (tPA) usually recommended prior to mechanical thrombectomy in the Japanese SKIP trial.
However, a similar strategy did prove to be non-inferior to combined thrombectomy and IV tPA in the Chinese DEVT trial.