UNASSIGNED: Background: Among the acute @entity385 @entity1 with large vessel occlusions and contraindications for the use of IV thrombolysis, mainly on oral anticoagulation or presenting too late, primary endovascular therapy is often performed as an alternative to the standard therapy even though evidence supporting the use of endovascular reperfusion therapies is not yet established. Using different statistical approaches, we compared the functional independence rates at 3 months among @entity1 undergoing primary endovascular therapy and @entity1 treated only with IV thrombolysis. Methods: We used data from a prospective, government-mandated and externally audited registry of reperfusion therapies for @entity385 (January 2011 to November 2012). @entity1 were selected if treated with either IV thrombolysis alone (n = 1,582) or primary endovascular thrombectomy (n = 250). A series of exclusions were made to homogenize the clinical characteristics among the two groups. We then carried out multivariate logistic regression and propensity score matching analyses on the final study sample (n = 1,179) to compare functional independence at 3 months, as measured by the modified Rankin scale scores 0-2, between the two groups. Results: The unadjusted likelihood of good outcome was poorer among the endovascular group (OR: 0.69; 95% CI: 0.47-1.0). After adjustment, no differences by treatment modality were seen (OR: 1.51; 95% CI: 0.93-2.43 for primary endovascular therapy). @entity1 undergoing endovascular thrombectomy within 180-270 min (OR: 2.89; 95% CI: 1.17-7.15) and @entity1 with severe @entity64 (OR: 1.84; 95% CI: 1.02-3.35) did better than their intravenous thrombolysis counterparts. The propensity score-matched analyses with and without adjustment by additional covariates showed that endovascular thrombectomy was as effective as intravenous thrombolysis alone in achieving functional independence (OR for unadjusted propensity score matched: 1.35; 95% CI: 0.9-2.02, OR for adjusted propensity score matched: 1.45; 95% CI: 0.91-2.32). Conclusion: This comparative effectiveness study shows that in @entity385 @entity1 with contraindications for IV thrombolysis, primary endovascular treatment might be an alternative therapy at least as effective as IV thrombolysis alone. Randomized controlled trials are urgently needed.    2014 S. Karger AG, Basel.

Functional Outcome After Primary Endovascular Therapy or IV Thrombolysis Alone for XXXX . An Observational, Comparative Effectiveness Study.

@entity1 :: ('9606', 'Species') :: ['patients', 'Patients'] @entity64 :: ('MESH:D020521', 'Disease') :: ['strokes'] @entity385 :: ('MESH:D002544', 'Disease') :: ['ischemic stroke']
@entity64 :: (MESH:D020521,Disease) :: ['Stroke']
