THRACE TRIAL : Mechanical thrombectomy is better than Alteplase alone in Stroke

Bracard S et el  in recently published THRACE trial compared mechanical thrombectomy in addition to standard Alteplase for stroke. Mechanical thrombectomy in addition to standard care improved clinical outcomes (functional independence at 3 months (odds ratio 1.55, 95% CI 1.05-2.30; p=0.028).

There was no difference in mortality or symptomatic intracranial hemorrhage in two groups.

Common adverse events related to thrombectomy were vasospasm (33 [23%] patients) and embolisation in a new territory (nine [6%]).

 

TRIAL

Funded by French ministry of health.

414 cases of acute ischaemic stroke and proximal cerebral artery occlusion were randomized to Alteplase {0.9 mg/kg [maximum 90 mg]} withing 4 hours (initial bolus of 10% of the total dose followed by infusion of the remaining dose over 60 min) or Alteplase plus Mechanical thrombectomy (within 5 hours). Occlusions had to be confirmed by CT or magnetic resonance angiography.

FOLLOW UP

Probably a larger trial, plus subgroup analysis of effect of timing of Alteplase/thrombectomy, artery, age and sex and operator results would be helpful in determining real beneficial patients.

IMPACT

This trial further strengthens already available evidence in support of thrombectomy

BOTTOMLINE

Move to a place where you have access to a hospital which has Alteplase and thrombectomy 24/7.

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