@article{2998774,
    title = "Intravenous thrombolysis or endovascular therapy for acute ischemic stroke associated with cervical internal carotid artery occlusion: the ICARO-3 study",
    author = "Paciaroni, M. and Inzitari, D. and Agnelli, G. and Caso, V. and Balucani, C. and Grotta, J.C. and Sarraj, A. and Sung-Il, S. and Chamorro, A. and Urra, X. and Leys, D. and Henon, H. and Cordonnier, C. and Dequatre, N. and Aguettaz, P. and Alberti, A. and Venti, M. and Acciarresi, M. and D’Amore, C. and Zini, A. and Vallone, S. and Dell’Acqua, M.L. and Menetti, F. and Nencini, P. and Mangiafico, S. and Barlinn, K. and Kepplinger, J. and Bodechtel, U. and Gerber, J. and Bovi, P. and Cappellari, M. and Linfante, I. and Dabus, G. and Marcheselli, S. and Pezzini, A. and Padovani, A. and Alexandrov, A.V. and Shahripour, R.B. and Sessa, M. and Giacalone, G. and Silvestrelli, G. and Lanari, A. and Ciccone, A. and De Vito, A. and Azzini, C. and Saletti, A. and Fainardi, E. and Orlandi, G. and Chiti, A. and Gialdini, G. and Silvestrini, M. and Ferrarese, C. and Beretta, S. and Tassi, R. and Martini, G. and Tsivgoulis, G. and Vasdekis, S.N. and Consoli, D. and Baldi, A. and D’Anna, S. and Luda, E. and Varbella, F. and Galletti, G. and Invernizzi, P. and Donati, E. and De Lodovici, M.L. and Bono, G. and Corea, F. and Sette, M.D. and Monaco, S. and Riva, M. and Tassinari, T. and Scoditti, U. and Toni, D.",
    journal = "Egyptian Journal of Neurology, Psychiatry and Neurosurgery",
    year = "2015",
    volume = "262",
    number = "2",
    pages = "459-468",
    publisher = "Dr. Dietrich Steinkopff Verlag GmbH and Co. KG",
    doi = "10.1007/s00415-014-7550-1",
    keywords = "alteplase;  urokinase, adult;  Article;  atrial fibrillation;  blood clot lysis;  brain hemorrhage;  brain ischemia;  cerebrovascular accident;  clinical trial;  cognition;  computer assisted tomography;  confidence interval;  controlled study;  death;  diabetes mellitus;  disability;  drug efficacy;  female;  functional assessment;  gaze;  human;  internal carotid artery occlusion;  language;  magnetic resonance angiography;  major clinical study;  male;  middle aged;  mortality;  motor performance;  National Institutes of Health Stroke Scale;  neglect;  nuclear magnetic resonance imaging;  physician;  priority journal;  Rankin scale;  scoring system;  ultrasound;  vision;  aged;  carotid artery thrombosis;  complication;  endovascular surgery;  fibrinolytic therapy;  procedures;  retrospective study;  Stroke, Aged;  Carotid Artery Thrombosis;  Endovascular Procedures;  Female;  Humans;  Male;  Middle Aged;  Retrospective Studies;  Stroke;  Thrombolytic Therapy",
    abstract = "The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0–2) or unfavourable (score of 3–6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88–1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40–0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5–6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86–1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of those treated with I.V. thrombolysis (27.4 %) (adjusted OR 1.75, 95 % CI 1.00–3.03, p = 0.05). Endovascular treatment of patients with acute ICA occlusion did not result in a better functional outcome than treatment with intravenous thrombolysis, but was associated with a higher rate of intracranial bleeding. Overall mortality was significantly reduced in patients treated with endovascular treatment but the rates of patients with severe disability or death were similar. When excluding all patients treated with the combination of I.V. thrombolysis and I.A. procedures, a potential benefit of I.A. treatment alone compared to I.V. thrombolysis was observed. © 2014, Springer-Verlag Berlin Heidelberg."
}