A Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke

作者：Chelsea S. Kidwell, Reza Jahan, Jeffrey Gornbein, Jeffry R. Alger, Val Nenov, Zahra Ajani, Lei Feng, Brett C. Meyer, Scott Olson, Lee H. Schwamm, Albert J. Yoo, Randolph S. Marshall, Philip M. Meyers, Dileep R. Yavagal, Max Wintermark, Judy Guzy, Sidney Starkman, Jeffrey L. Saver · 发表于：New England Journal of Medicine · 年份：2013 · DOI：10.1056/nejmoa1212793 · 被引用次数：1385 · 研究领域：Acute Ischemic Stroke Management、Cerebrovascular and Carotid Artery Diseases、Intracerebral and Subarachnoid Hemorrhage Research

BACKGROUND: Whether brain imaging can identify patients who are most likely to benefit from therapies for acute ischemic stroke and whether endovascular thrombectomy improves clinical outcomes in such patients remains unclear. METHODS: In this study, we randomly assigned patients within 8 hours after the onset of large-vessel, anterior-circulation strokes to undergo mechanical embolectomy (Merci Retriever or Penumbra System) or receive standard care. All patients underwent pretreatment computed tomography or magnetic resonance imaging of the brain. Randomization was stratified according to whether the patient had a favorable penumbral pattern (substantial salvageable tissue and small infarct core) or a nonpenumbral pattern (large core or small or absent penumbra). We assessed outcomes using the 90-day modified Rankin scale, ranging from 0 (no symptoms) to 6 (dead). RESULTS: Among 118 eligible patients, the mean age was 65.5 years, the mean time to enrollment was 5.5 hours, and 58% had a favorable penumbral pattern. Revascularization in the embolectomy group was achieved in 67% of the patients. Ninety-day mortality was 21%, and the rate of symptomatic intracranial hemorrhage was 4%; neither rate differed across groups. Among all patients, mean scores on the modified Rankin scale did not differ between embolectomy and standard care (3.9 vs. 3.9, P=0.99). Embolectomy was not superior to standard care in patients with either a favorable penumbral pattern (mean score, 3.9 vs. 3.4;...