PSA 2013 Stroke Update

Recent advances in stroke treatment

Transcript

1. Stroke Breaking News and Year in Review Alexander Flint, M.D., Ph.D. NCC and Stroke, Kaiser RWC CMO, image32 @neuroicudoc www.neuroicudoc.com
2. Good news! •CHANCE •PREDIMED •SWIFT •TREVO-2 Complicated news... •IMS-III •SYNTHESIS
3. First, the good news.
4. • 5170 patients • Minor stroke (NIHSS < 3) or TIA (ABCD2 > 4) • RCT: • aspirin vs. • clopidogrel load, then clopidogrel + aspirin for 21 days
9. SWIFT and TREVO-2
11. SWIFT vs.
13. TREVO-2 vs.
15. Now, the complicated news.
16. IMS-III & SYNTHESIS Now, the complicated news.
17. The Headline
18. • 656 patients, NIHSS 8 or higher • 2/3 = EST after low-dose IV t-PA vs. 1/3 = usual IV t-PA • Any approved thrombectomy device: • IA t-PA only (n=51), MicroSonic SV system (n=14), Merci (n=77), Penumbra (n=39), Solitaire (n=4).
19. • Good reperfusion (TICI 2b or 3) was achieved in about 44% • sICH: • EST = 6.2% • IV tPA = 5.9%
21. 42.7% vs 40.2% 23.8% vs 16.8% (P=0.25) (P=0.06)
22. • 362 patients, any NIHSS score • 1/2 = EST up to 6 hours vs. • 1/2 = IV tPA up to 4.5 hours • EST was “locoregional IA t-PA” and “guidewire fragmentation” • Only 56 received a device
25. “First Generation or Second Generation Endovascular Stroke Treatment Options Are Roughly Equivalent to IV tPA”
26. 3G EST > 2G EST IV tPA = 2G EST 3G EST > IV tPA ?
27. New Trials •SWIFT PRIME •DAWN •many others
28. In the meantime...
29. In the meantime... IV tPA + 3G EST ?
31. Angiogram