Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection
Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection
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DOI：
10.1056/nejmoa1414792
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发表时间：
2015-03-12
影响因子：
158.5
通讯作者：
Davis, S. M.
中科院分区：
文献类型：
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作者：
Campbell, B. C. V.;Mitchell, P. J.;Davis, S. M.
背景对缺血性中风进行血管内治疗的试验结果各不相同。我们随机分配在缺血性卒中发生后 4.5 小时内接受每公斤体重 0.9 毫克阿替普酶治疗的缺血性卒中患者接受 Solitaire FR（血流恢复）支架回取器进行血管内血栓切除术或继续单独接受阿替普酶治疗。所有患者均为颈内动脉或大脑中动脉闭塞，计算机断层扫描（CT）灌注成像显示有可挽救的脑组织和小于70毫升的缺血核心。24小时再灌注和早期神经功能改善（美国国立卫生研究院卒中量表评分减少>=8分，或第3天评分为0或1分）是主要的共同结果。次要结果包括 90 天时改良兰金量表的功能评分。结果试验在 70 名患者（每组 35 名患者）接受随机化后因疗效问题提前结束。血管内治疗组在 24 小时内对缺血区域进行再灌注的比例高于单纯阿替普酶组（中位数，100% 对 37%；P＜0.05）。
BACKGROUNDTrials 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.METHODSWe 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.RESULTSThe 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