Improvements in recanalization with modern stroke therapy: a review of prospective ischemic stroke trials during the last two decades.
INTRODUCTION
A number of recent trials evaluating intra-arterial therapies for acute ischemic stroke have been completed. We present a review of prospective acute ischemic stroke trials reported in a peer-reviewed forum during the last 20 years to provide insight into the general direction of this rapidly evolving field.


METHODS
Prospective trials evaluating acute stroke intra-arterial therapies since 1999 were included, with the National Institute of Neurological Disorders and Stroke rtPA trial published in 1995 as a baseline comparator. Patient presenting factors and outcome data were analyzed based on year of publication and best-fit lines and linear regression analyses were generated.


RESULTS
Thirteen prospective trials were included. Regression analyses demonstrated no appreciable change in the median NIH Stroke Scale score of subjects at the time of enrollment since 1995 (p=0.44) and no appreciable improvements in good outcome based on a modified Rankin score of 0-2 at 90 days (p=0.66) or mortality at 90 days (p=0.55). A significant increase in time from onset of symptoms to treatment among enrolled patients was noted from 1995 to 2012 (p=0.03). In addition, a significant improvement in recanalization/reperfusion was noted over the last two decades (p=0.02).


CONCLUSIONS
This review of prospective acute ischemic stroke trials since 1999 indicates a substantial improvement in revascularization in the setting of a significant increase in time to therapy onset, but no appreciable change in good functional outcome.
['Fargen|Kyle M|KM|', 'Meyers|Philip M|PM|', 'Khatri|Pooja|P|', 'Mocco|J|J|']
D002545:Brain Ischemia D002548:Cerebral Revascularization D002986:Clinical Trials as Topic D057510:Endovascular Procedures D006801:Humans D016014:Linear Models D011446:Prospective Studies D015424:Reperfusion D020521:Stroke D017131:Thrombectomy D016896:Treatment Outcome
Stroke Intervention Thrombectomy Thrombolysis