Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke
Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke
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DOI：
10.1056/nejmoa1414905
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发表时间：
2015-03-12
影响因子：
158.5
通讯作者：
Hill, M. D.
中科院分区：
文献类型：
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作者：
Goyal, M.;Demchuk, A. M.;Hill, M. D.
研究背景在前循环近端血管闭塞的患者中，60 - 80%的患者在卒中发作后90天内死亡，或尽管阿替普酶治疗仍不能恢复功能独立性。我们评估了快速血管内治疗除了标准治疗急性缺血性卒中患者的小梗死核心，近端颅内动脉闭塞，和中度至良好的侧支循环。METHODSWe随机分配参与者接受标准治疗（对照组）或标准治疗加血管内治疗与使用可用的血栓切除术设备（干预组）。前循环近端颅内闭塞的患者在症状发作后12小时内入选。排除了计算机断层扫描（CT）和CT血管造影显示的大梗死核心或侧支循环不良的患者。根据预定目标测量工作流程时间。主要结局是90天时改良兰金量表评分（范围，0 [无症状]至6 [死亡]）。采用比例优势模型计算共同优势比，作为干预导致改良兰金量表评分低于对照组评分的可能性的量度（偏移分析）。在全球22个中心，招募了316名参与者，其中238名接受静脉注射阿替普酶（干预组120名，对照组118名）。在干预组中，从头部研究CT到首次再灌注的中位时间为84分钟。功能独立率（90天改良兰金评分为0 - 2）随着干预的增加而增加（53.0%，对照组为29.3%; P
BACKGROUNDAmong patients with a proximal vessel occlusion in the anterior circulation, 60 to 80% of patients die within 90 days after stroke onset or do not regain functional independence despite alteplase treatment. We evaluated rapid endovascular treatment in addition to standard care in patients with acute ischemic stroke with a small infarct core, a proximal intracranial arterial occlusion, and moderate-to-good collateral circulation.METHODSWe randomly assigned participants to receive standard care (control group) or standard care plus endovascular treatment with the use of available thrombectomy devices (intervention group). Patients with a proximal intracranial occlusion in the anterior circulation were included up to 12 hours after symptom onset. Patients with a large infarct core or poor collateral circulation on computed tomography (CT) and CT angiography were excluded. Workflow times were measured against predetermined targets. The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. A proportional odds model was used to calculate the common odds ratio as a measure of the likelihood that the intervention would lead to lower scores on the modified Rankin scale than would control care (shift analysis).RESULTSThe trial was stopped early because of efficacy. At 22 centers worldwide, 316 participants were enrolled, of whom 238 received intravenous alteplase (120 in the intervention group and 118 in the control group). In the intervention group, the median time from study CT of the head to first reperfusion was 84 minutes. The rate of functional independence (90-day modified Rankin score of 0 to 2) was increased with the intervention (53.0%, vs. 29.3% in the control group; P