Poor natural history of large vessel acute ischemic stroke underscores the need for mechanical thrombectomy: natural history FIRST stroke study interim results

Vallabh Janardhan, Lauren A. Carlson, Ryan M. Gianatasio, Sherman H. Chen, Parita Bhuva, Mark M. Murray, Madhu B. Vijayappa, Paul A. Hansen, Anita Guthmann, Raymond Cheung, Thomas Leung, Iris Grunwald, Heather Hernandez, Leticia Barraza, Hope Buell, Sophia S. Kuo, Arani Bose, Siu Po Sit

Research output: Contribution to journalConference articlepeer-review

Abstract

Background: Limited information is available on the natural history of the mechanical thrombectomy-eligible stroke cohort. Therefore, FIRST aims to collect real-world data in an appropriate population.
Methods: The FIRST Trial is a prospective natural history study of a stroke cohort eligible for but untreated by endovascular therapy presenting with a large vessel occlusion and ineligible for or unresponsive to IV rtPA. The primary endpoint is 90-day mRS 0–2.
Results: Sixty-one patients met analysis criteria. Mean age was 68; median NIHSS score was 18. Occlusions were in the ICA (28%), MCA (67%) and other (5%). The admission TIMI 0–1 rate was 98% and TICI 0–1 was 98%, in which10% and 12% spontaneously recanalized. Good 90-day out-come was achieved in 22%; 41% died, 54% had SAEs and 56% were IV rtPA-refractory. Compared to PROACT II, the FIRST cohort has substantially different entry criteria, less recanalization and worse outcome.
Conclusion: If untreated, 78% of patients with large vessel acute ischemic stroke will die or suffer long-term disabilities. Results suggest FIRST data could provide a benchmark for future thrombectomy trials. Study supported by: Penumbra, Inc.
Original languageEnglish
Article numberM1304
Pages (from-to)S55-S55
Number of pages1
JournalAnnals of Neurology
Volume74
Issue numbersuppl 17
Publication statusPublished - 2013
Event42nd Annual Meeting of the Child Neurology Society - Texas, United States
Duration: 30 Oct 20132 Nov 2013

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