Maqola

Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection

Bruce CampbellThe authors' affiliations are listed in the AppendixPeter MitchellTimothy KleinigUniversity of Melbourne, Parkville, VIC, Royal Adelaide Hospital, Adelaide, SAHelen M. DeweyAustin Health, Heidelberg, VICLeonid ChurilovFlorey Institute of Neuroscience and Mental HealthNawaf YassiDepartment of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne HospitalBernard YanDepartment of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne HospitalRichard DowlingMark ParsonsPriority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, NSWThomas J. OxleyDepartment of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne HospitalTeddy Y. WuDepartment of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne HospitalMark BrooksAustin Health, Heidelberg, VICMarion SimpsonAustin Health, Heidelberg, VICFerdinand MiteffDepartment of Radiology, Royal North Shore HospitalChristopher LeviPriority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, NSWMartín KrauseDepartment of Neurology, Royal North Shore Hospital and Kolling Institute, University of SydneyTimothy HarringtonDepartment of Radiology, Royal North Shore HospitalKenneth FaulderDepartment of Radiology, Royal North Shore HospitalBrendan SteinfortDepartment of Radiology, Royal North Shore HospitalMiriam PriglingerDepartment of Neurology, Royal North Shore Hospital and Kolling Institute, University of SydneyTimothy AngPriority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, NSWRebecca ScroopDepartment of Neurolo-gy, Royal Melbourne Hospital, Grattan St., Parkville, VIC 3050, Australia,P. Alan BarberCentre for Brain Research, University of Auckland, Auckland City HospitalBen McGuinnessAuckland City HospitalTissa WijeratneSt. Leonards, NSW, Western Hospital, Footscray, VICThanh G. PhanMonash Medical Centre, Monash University, Clayton, VICWinston ChongMonash Medical Centre, Monash University, Clayton, VICRonil V. ChandraMonash Medical Centre, Monash University, Clayton, VICChristopher F. BladinBox Hill HospitalMonica BadveMonash University, Box Hill, VIC, and Gold Coast University Hospital, Southport, QLDHenry E. RiceMonash University, Box Hill, VIC, and Gold Coast University Hospital, Southport, QLDLaetitia de VilliersMonash University, Box Hill, VIC, and Gold Coast University Hospital, Southport, QLDHenry MaFlorey Institute of Neuroscience and Mental HealthPatricia DesmondGeoffrey A. DonnanFlorey Institute of Neuroscience and Mental HealthStephen M. DavisDepartment of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital

2015en

ABI

Annotatsiya

BACKGROUND: Trials of endovascular therapy for ischemic stroke have produced variable results. We conducted this study to test whether more advanced imaging selection, recently developed devices, and earlier intervention improve outcomes. METHODS: We randomly assigned patients with ischemic stroke who were receiving 0.9 mg of alteplase per kilogram of body weight less than 4.5 hours after the onset of ischemic stroke either to undergo endovascular thrombectomy with the Solitaire FR (Flow Restoration) stent retriever or to continue receiving alteplase alone. All the patients had occlusion of the internal carotid or middle cerebral artery and evidence of salvageable brain tissue and ischemic core of less than 70 ml on computed tomographic (CT) perfusion imaging. The coprimary outcomes were reperfusion at 24 hours and early neurologic improvement (≥8-point reduction on the National Institutes of Health Stroke Scale or a score of 0 or 1 at day 3). Secondary outcomes included the functional score on the modified Rankin scale at 90 days. RESULTS: The trial was stopped early because of efficacy after 70 patients had undergone randomization (35 patients in each group). The percentage of ischemic territory that had undergone reperfusion at 24 hours was greater in the endovascular-therapy group than in the alteplase-only group (median, 100% vs. 37%; P<0.001). Endovascular therapy, initiated at a median of 210 minutes after the onset of stroke, increased early neurologic improvement at 3 days (80% vs. 37%, P=0.002) and improved the functional outcome at 90 days, with more patients achieving functional independence (score of 0 to 2 on the modified Rankin scale, 71% vs. 40%; P=0.01). There were no significant differences in rates of death or symptomatic intracerebral hemorrhage. CONCLUSIONS: In patients with ischemic stroke with a proximal cerebral arterial occlusion and salvageable tissue on CT perfusion imaging, early thrombectomy with the Solitaire FR stent retriever, as compared with alteplase alone, improved reperfusion, early neurologic recovery, and functional outcome. (Funded by the Australian National Health and Medical Research Council and others; EXTEND-IA ClinicalTrials.gov number, NCT01492725, and Australian New Zealand Clinical Trials Registry number, ACTRN12611000969965.).

Hali tarjima qilinmagan

Identifikatorlar

DOI: 10.1056/nejmoa1414792

Iqtiboslar va manbalar

2 ta iqtibos0 ta foydalanilgan manba

Koʻrsatkichlar — AkademScholar