Stroke Treatment Gets Boost From New Clot Retrievers

Despite modest sample sizes, the "carefully done" SWIFT and TREVO 2 trials begin to answer the call for high-level evidence about the efficacy and safety of mechanical clot retrieval devices in acute ischemic stroke, Dr. Philip B. Gorelick wrote in an editorial accompanying the Lancet articles.

"It will be interesting to learn, on the basis of future non-primary analyses, whether collateral flow patterns or clot characteristics elucidate propensity for treatment response," he said (Lancet 2012 Aug. 26 [doi: 10.1016/S0140-6736(12)61302-6]).

He also stated that the "mechanistic basis for superiority" of these next-generation devices might relate to retention of structural integrity of the clot and vessel wall during the procedure.

"Future randomized trials of these and other, newer devices will need to take into account comparison or complementary treatment with rt-PA [recombinant tissue plasminogen activator], or with newer-generation thrombolytics such as desmoteplase and tenecteplase," he said.

Meanwhile, SWIFT and TREVO 2 represent major steps forward, and pave the way for new treatment options, as well as for further validation by additional study, he said.

Dr. Gorelick is with the Hauenstein Neuroscience Center and Michigan State University College of Human Medicine in Grand Rapids. He disclosed that he receives remuneration as co-director of the clinical coordinating center for the DIAS trial that involves desmoteplase.