To compare the outcomes between endovascular and medical management of acute ischemic stroke in recent randomized controlled trials (RCT).
A systematic literature review was performed, and multicenter, prospective RCTs published from January 1, 2013, to May 1, 2015, directly comparing endovascular therapy to medical management for patients with acute ischemic stroke were included. Meta-analyses of modified Rankin Scale (mRS) and mortality at 90 days and symptomatic intracranial hemorrhage (sICH) for endovascular therapy and medical management were performed.
Eight multicenter, prospective RCTs (Interventional Management of Stroke [IMS] III, Local Versus Systemic Thrombolysis for Acute Ischemic Stroke [SYNTHESIS] Expansion, Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy [MR RESCUE], Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands [MR CLEAN], Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness [ESCAPE], Extending the Time for Thrombolysis in Emergency Neurological Deficits–Intra-Arterial [EXTEND-IA], Solitaire With the Intention For Thrombectomy as Primary Endovascular Treatment [SWIFT PRIME], and Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours [REVASCAT]) comprising 2,423 patients were included. Meta-analysis of pooled data demonstrated functional independence (mRS 0–2) at 90 days in favor of endovascular therapy (odds ratio [OR] = 1.71; p = 0.005). Subgroup analysis of the 6 trials with large vessel occlusion (LVO) criteria also demonstrated functional independence at 90 days in favor of endovascular therapy (OR = 2.23; p < 0.00001). Subgroup analysis of the 5 trials that primarily utilized stent retriever devices (≥70%) in the intervention arm demonstrated functional independence at 90 days in favor of endovascular therapy (OR = 2.39; p < 0.00001). No difference was found for mortality at 90 days and sICH between endovascular therapy and medical management in all analyses and subgroup analyses.
1. America's Essential Hospitals (non-profit entity) - legislative briefing on telehealth - compensation for travel, food, hotel
Provisional Patent Application: Serial Number 61/867,477, entitled ?Method, System and Computer Readable Medium for Improving Treatment Times for Rapid Evaluation of Acute Stroke via Mobile Telemedicine,? filed on August 19, 2013
1. Stroke Hyperglycemia Insulin Network Effort (SHINE) NINDS/NIH U-01 NS 069498 2. Health Resources Services Administration - Evidence based tele- emergency network grant (RURAL EQUIT-E Project) HRSA G01RH27869
1. American Heart Association-American Stroke Association National Clinical Research Program, Cervical Artery Dissection Expression (CADEX) AHA 3CRP141400001 2. American Academy of Neurology - Education Research Grant 3. American Board of Psychiatry and Neurology - Faculty Fellowship Award
Neurology: Associate Editor 1 July 2009 - present Seminars in Neurology Editorial Board 2006-2014
NINDS/NIH - R01 NS 069763 (co-investigator) 2010-2016 NINDS/NIH ? U-01 NS069208 (co-Prinicpal Investigator) 2010-2015 NHGRI/NIH ? U-01 HG005160 (co-Principal Investigator) 2009-2014
University of Virginia - CENETERS OF EXCELLENCE CLINICAL RESEARCH GRANT SUPPORT - The UVA BRAIN AND AORTIC ANEURYSM SCREENING (BAAS) study - Principal Investigator 10/13-9/15
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