ANVC and MEdia
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News to Use
We have seen several studies in the past year regarding outcomes associated with endovascular treatment alone for large artery occlusion versus endovascular treatment with IV thrombolysis, and at times, the conclusions seem to contradict each other. Ahmed and colleagues recently published “Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without Intravenous Thrombolysis.”1 They used the SITS-International Stroke Thrombectomy Register and identified 6,350 patients who met the eligibilty criteria. They found that  patients with combination IV thrombolysis and endovascular therapy had a statistically significant higher rate of functional independence and less death at three months without significant differences in symptomatic ICH.  Although this study was limited by its design and possible confounders associated with registry data, the authors suggest that this study supports Class II evidence for pre-treatment with IV thrombolytics prior to endovascular interventions for eligible patients.

Yang and the DIRECT MT investigators published a randomized controlled trial of 656 eligible patients with large artery occlusions who were randomized to endovascular treatment with IV thrombolysis versus endovascular treatment without IV thrombolysis.2  Although they concluded that endovascular treatment alone was not inferior to the combination of IV thrombolysis and endovascular treatment on 90-day modified Rankin scale scores, the generous non-inferiority margin (20%) may not rule out the impact of IV thrombolytics after all. The non-inferiority margin selected in this study means that only 80% of the endovascular only group needed to perform similarly to the outcomes produced by the combination of IV thrombolysis and endovascular intervention. Generally, if something is truly non-inferior, it should show no more than a 3% difference in comparison to the accepted superior treatment (i.e. non-inferiority in this context would mean that 97% of patients undergoing endovascular treatment without thrombolysis achieved a similar outcome). This leaves us questioning whether endovascular treatment without thrombolysis is truly non-inferior.

Click here for more information on the relevance and interpretation of non-inferiority margins in research.3 

1.             Ahmed N, Mazya M, Nunes AP, et al. Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without Intravenous Thrombolysis. Neurology 2021:10.1212/WNL.0000000000012327.

2.             Yang P, Zhang Y, Zhang L, et al. Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. New England Journal of Medicine 2020;382:1981-93.

3.             Mauri L, D’Agostino RB. Challenges in the Design and Interpretation of Noninferiority Trials. New England Journal of Medicine 2017;377:1357-67.

ANVC Calendar – July
Click HERE for the 2021 calendar to register for the following ANVC events as well as to register for events throughout the year.

ANVC Webinar Series Continues (registered attendees will obtain 1 hour CE)
     Thursday July 15  |  1:00PM EDT – 2:00PM EDT

     Make It Count: Strategies for Publishing Your Work
     Anne Alexandrov, PhD, AGACNP-BC, ANVP-BC, NVRN-BC, CCRN, FAAN

ASC Course – Virtual
     Fri/Sat July 30 – 31  |  10:00 AM EDT – 4:15PM EDT

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