Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

作者：Mayank Goyal, Andrew M. Demchuk, Bijoy K. Menon, Muneer Eesa, Jeremy Rempel, John Thornton, Daniel Roy, Tudor G. Jovin, Robert A. Willinsky, Biggya L. Sapkota, Dar Dowlatshahi, Donald Frei, Noreen Kamal, Walter Montanera, Alexandre Y. Poppe, Karla J. Ryckborst, Frank L. Silver, Ashfaq Shuaib, Donatella Tampieri, David Williams, Oh Young Bang, Blaise Baxter, Paul Burns, Hana Choe, Ji Hoe Heo, Christine A Holmstedt, Brian T. Jankowitz, Michael Kelly, Guillermo Linares, Jennifer Mandzia, Jai Shankar, Sung‐Il Sohn, Richard H. Swartz, Philip A. Barber, Shelagh B. Coutts, Eric E. Smith, William Morrish, Alain Weill, Suresh Subramaniam, Alim P. Mitha, John Wong, Mark Lowerison, Tolulope T. Sajobi, Michael D. Hill · 发表于：New England Journal of Medicine · 年份：2015 · DOI：10.1056/nejmoa1414905 · 被引用次数：6117 · 研究领域：Acute Ischemic Stroke Management、Cerebrovascular and Carotid Artery Diseases、Stroke Rehabilitation and Recovery

BACKGROUND: Among 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. METHODS: We 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). RESULTS: The 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 contr...