Extracranial Carotid Disease and Effect of Intra-arterial Treatment in Patients With Proximal Anterior Circulation Stroke
Authors: Feng Ye, Yu Zhang, Rongrui Tang
Journal: Annals of Internal Medicine (2018)

Letters2 January 2018Extracranial Carotid Disease and Effect of Intra-arterial Treatment in Patients With Proximal Anterior Circulation StrokeFeng Ye, MD, Yu Zhang, MD, and Rongrui Tang, MDFeng Ye, MDDeyang City Hospital, Deyang, China (F.Y.)Search for more papers by this author, Yu Zhang, MDChengdu University, Chengdu, China (Y.Z.)Search for more papers by this author, and Rongrui Tang, MDBishan Hospital, Chongqing, China (R.T.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0492 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Berkhemer and colleagues (1) report a post hoc analysis of MR CLEAN (Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands) and conclude that intra-arterial treatment (IAT) may be at least as effective in patients with extracranial carotid disease (ECD) as in those without this condition. However, we have noted key limitations.The primary effect variable was adjusted for time from stroke onset to randomization in the study, but we contend that adjusting for median time to reperfusion would have been better because this factor more directly affects the outcome. The median ...References1. Berkhemer OA, Borst J, Kappelhof M, Yoo AJ, van den Berg LA, Fransen PSS, et al; MR CLEAN Investigators. Extracranial carotid disease and effect of intra-arterial treatment in patients with proximal anterior circulation stroke in MR CLEAN. Ann Intern Med. 2017;166:867-75. [PMID: 28531910]. doi:10.7326/M16-1536 LinkGoogle Scholar2. Campbell BCV, Donnan GA, Lees KR, Hacke W, Khatri P, Hill MD, et al. Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke. Lancet Neurol. 2015;14:846-54. [PMID: 26119323] doi:10.1016/S1474-4422(15)00140-4 CrossrefMedlineGoogle Scholar3. Sheth SA, Jahan R, Gralla J, Pereira VM, Nogueira RG, Levy EI, et al; SWIFT-STAR Trialists. Time to endovascular reperfusion and degree of disability in acute stroke. Ann Neurol. 2015;78:584-93. [PMID: 26153450] doi:10.1002/ana.24474 CrossrefMedlineGoogle Scholar4. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al; American Heart Association Stroke Council. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:3020-35. [PMID: 26123479] doi:10.1161/STR.0000000000000074 CrossrefMedlineGoogle Scholar5. Brinjikji W, Murad MH, Rabinstein AA, Cloft HJ, Lanzino G, Kallmes DF. Conscious sedation versus general anesthesia during endovascular acute ischemic stroke treatment: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36:525-9. [PMID: 25395655] doi:10.3174/ajnr.A4159 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Deyang City Hospital, Deyang, China (F.Y.)Chengdu University, Chengdu, China (Y.Z.)Bishan Hospital, Chongqing, China (R.T.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0492. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoExtracranial Carotid Disease and Effect of Intra-arterial Treatment in Patients With Proximal Anterior Circulation Stroke in MR CLEAN Olvert A. Berkhemer , Jordi Borst , Manon Kappelhof , Albert J. Yoo , Lucie A. van den Berg , Puck S.S. Fransen , Debbie Beumer , Wouter J. Schonewille , Paul J. Nederkoorn , Marieke J.H. Wermer , Henk A. Marquering , Hester F. Lingsma , Yvo B.W.E.M. Roos , Robert J. van Oostenbrugge , Diederik W.J. Dippel , Wim H. van Zwam , Charles B.L.M. Majoie , Bart J. Emmer , Aad van der Lugt , and Extracranial Carotid Disease and Effect of Intra-arterial Treatment in Patients With Proximal Anterior Circulation Stroke Olvert Berkhemer and Aad van der Lugt Extracranial Carotid Disease and Effect of Intra-arterial Treatment in Patients With Proximal Anterior Circulation Stroke Volker Maus , Nuran Abdullayev , Marios Nikos Psychogios , Daniel Behme , and Anastasios Mpotsaris Metrics 2 January 2018Volume 168, Issue 1Page: 82-83KeywordsDisclosureGeneral anesthesiaIschemic strokePatientsReperfusionRevascularizationSedationStrokeSystematic reviews ePublished: 2 January 2018 Issue Published: 2 January 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...