Immediate Angiography Could Preserve Function, Improve Outcomes in LVO Stroke

Data presented in a late-breaking session as part of the American Stroke Association’s International Stroke Conference (ISC) 2021 provides evidence suggesting immediate angiography could be a more effective approach than standard computed tomography (CT) scan for strokes caused by a large vessel occlusion.

An interim analysis of 150 stroke patients from a randomized study, data from the ANGIOCAT trial indicate receiving immediate angiography was associated with a reduction in in-hospital delays, increased odds of undergoing endovascular treatment, and improved disability scores compared to standard CT scans.

“Stroke patients transferred directly to an angiography suite were less likely to be dependent for assistance with daily activities compared to the stroke patients who received the current standard of care—CT scan,” Manuel Requena, PhD, a neurologist and neurointerventionalist fellow at Vall d'Hebron Hospital in Barcelona, Spain, in a statement. “More frequent and more rapid treatment can help improve outcomes for our stroke patients.”

Launched in 2018, ANGIOCAT was designed to assess the efficacy of a direct transfer to angio-suite (DTAS) of patients with a suspected LVO stroke admitted to the Vall d’Hebron Hospital within 6 hours of symptom onset.

The interim analysis presented at ISC 21 represented data from the first 150 patients included in the study. This patient group had a mean age of 73.0±13.1 years, a mean onset to door time of 224.9±103.4 minutes, a median admission NIHSS of 18 (14-21), and the rate of direct admissions was 32.6%.

Investigators noted there were no significant differences in baseline variables observed between either study arms. Additionally, investigators found rates of spontaneous intracerebral hemorrhage, LVO strokes, and intravenous tissue plasminogen activator (tPA) treatment were similar between the study arms.

In an intention to treat analysis of 128 patients, endovascular treatment was not performed among 9.5% of patients randomized to CT and 0% among those randomized to DTAS (P=.01). Further analysis indicated DTAS was associated with a reduced door to groin time (19 [IQR 15-24] vs 43 [37-52] minutes; P <.01) and reduced onset to reperfusion time (277.2±110 vs 331.0±121 minutes; P=.015).

Additionally, the interim analysis suggests DTAS was associated with reduced severity of disability over the range of the modified Rankin Score at 3 months, with an adjusted odds ratio for 1-point improvement of 2.14 (95% CI, 1.10-4.18; P=.014). Meanwhile, investigators found rates of symptomatic intracerebral hemorrhage and in-hospital mortality were comparable between the study arms.

Investigators cautioned clinicians to consider the limitations within their study before overinterpretation of results. These limitations included the study center already possessing extensive experience in immediate angiography and the lack of monitoring by an external review group. These limitations withstanding, investigators purport the results of their study provide evidence that warrants further examination of immediate angiography for improving functionality and outcomes following LVO strokes.

“Our study is the first clinical trial that shows the superiority of direct transfer to an angiography suite,” said Requena. “Our findings were close to what we expected, and we were surprised that they occurred so early in the study. We trust that they will be confirmed in ongoing, multicenter, international trials.”

This study, “Evaluation Of Direct Transfer To Angiography Suite Vs. Computed Tomography Suite In Endovascular Treatment Of Stroke: ANGIO-CAT Randomized Clinical Trial,” was presented at ISC 21.