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Table of Contents    
CORRESPONDENCE
Year : 2014  |  Volume : 62  |  Issue : 4  |  Page : 474-475

Authors reply


Narayana Health Institute of Neurosciences, Narayana Health Mazumdar Shaw Medical Center, Bangalore, Karnataka, India

Date of Web Publication19-Sep-2014

Correspondence Address:
V Huded
Narayana Health Institute of Neurosciences, Narayana Health Mazumdar Shaw Medical Center, Bangalore, Karnataka
India
V Huded
Narayana Health Institute of Neurosciences, Narayana Health Mazumdar Shaw Medical Center, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.141301

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How to cite this article:
Huded V, De Souza R, Nagarajaiah R K, Zafer S M, Nair R, Acharya H, Huded V, De Souza R, Nagarajaiah R K, Zafer S M, Nair R, Acharya H. Authors reply. Neurol India 2014;62:474-5

How to cite this URL:
Huded V, De Souza R, Nagarajaiah R K, Zafer S M, Nair R, Acharya H, Huded V, De Souza R, Nagarajaiah R K, Zafer S M, Nair R, Acharya H. Authors reply. Neurol India [serial online] 2014 [cited 2019 Dec 9];62:474-5. Available from: http://www.neurologyindia.com/text.asp?2014/62/4/474/141301


Sir,

In the Interventional Management of Stroke III (IMS3) [1] study, the participants were randomly assigned, either to the intravenous arm or to the endovascular treatment arm. CT angiogram was not consistently used as a parameter for evaluating strokes due to large vessel occlusions. Some of the patients randomized to the endovascular group showed no evidence of any vascular lesion. It is difficult to comment as to how many patients who received intravenous thrombolysis (IVT) and showed good improvement actually had a transient ischemic attack (TIA) or were functional. The initial criterion used in the study was a National Institutes of Health Stroke Scale (NIHSS) of greater than 10, suggestive of a large vessel occlusion. A high NIHSS score may also be seen in a left middle cerebral artery (MCA) infarct in spite of the aetiology not being a large vessel occlusion. In this trial, stent retrievers were used in very few patients.

In our series, seven out of 45 patients received IVT prior to endovascular treatment, while others either had contraindications to IVT or were outside the window period for IVT. All patients receiving both IVT and endovascular had good outcomes compared to 52% in endovascular alone (P < 0.05). In our previously published data of thrombolysis in acute ischemic stroke, among patients with strokes due to large vessel occlusions, 63% of patients who underwent endovascular treatment had good outcomes compared to 44% of patients who received IVT alone. [2]

Out of 45, 18 patients had a cardioembolic stroke, of which 12 (67%) had good outcome compared to 17 out of 27 (63%) in the non-embolic group (P > 0.05). The mean onset-to-recanalization time was 353 minutes. Patients with onset-to-recanalization times more than 420 minutes had consistently poor outcomes. Four patients who achieved complete recanalization underwent decompression.

We agree that currently IVT is the gold standard for treatment of acute ischemic stroke patients presenting in the window period, however, we feel that patients who have documented large vessel occlusions will benefit from endovascular treatment. Larger randomized trials are needed to compare the outcome of acute ischemic stroke patients receiving endovascular treatment versus IVT in patients with documented large vessel occlusions.

 
  References Top

1.Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 2013;368:893-903.  Back to cited text no. 1
    
2.Huded V, De Souza R, Nagarajaiah RK, Zafer SM, Nair R, Acharya H. Thrombolysis in acute ischemic stroke: Experience from a tertiary care centre in India. J Neurosci Rural Pract 2014;5:25-30.  Back to cited text no. 2
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