So far, we’ve seen nothing but poor outcomes in endovascular cerebral reperfusion trials. The MERCI devices were simply dysfunctional and lethal and, despite advances with newer devices, we’re still waiting for a decisive trial demonstrating clear benefit. But, the money is out there for the taking if the science will support it – and thus, more “science”.
This is a study involving authors sponsored by Stryker who do a retrospective review of cases at two hospitals, comparing infarct volume and short-term outcomes of patients who underwent either endovascular intervention, conventional thrombolysis, or no treatment for their large-vessel acute ischemic stroke. The accompanying editorial probably sums up their limitations best:
“Retrospective, nonrandomized nature of the study; the comparison between 2 hospitals in the same health care system in which endovascular interventions were performed in one and not the other, which may have resulted in some unintentional differences in overall care; the combining of data among patients who received intravenous thrombolysis with those who received no reperfusion therapy, which may have diluted treatment responses; … and the lack of long-term clinical outcomes that could be correlated with the imaging findings.”
So, they have a collection of patients for whom it is in no way appropriate to compare outcomes and generalize any sort of conclusions – and that’s precisely what they do. And, specifically, after reporting full-cohort baseline characteristics, their conclusions are based on subgroups of that cohort – and using an imaging surrogate outcome measure!
I’d tell you these authors conclude patients with an NIHSS of 14 or higher may be the best candidates for endovascular reperfusion therapy – but then I’d be further perpetuating this “science”. Again, what they claim may be true – but they’re overestimating the ability of their data to claim it.
“Comparison of Final Infarct Volumes in Patients Who Received Endovascular Therapy or Intravenous Thrombolysis for Acute Intracranial Large-Vessel Occlusions”
http://archneur.jamanetwork.com/article.aspx?articleid=1686897