Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct

作者：Raul G. Nogueira, Ashutosh P. Jadhav, Diogo C Haussen, Alain Bonafé, Ronald F. Budzik, Parita Bhuva, Dileep R. Yavagal, Marc Ribó, Christophe Cognard, Ricardó A. Hanel, Cathy Sila, Ameer E Hassan, Monica A. Millan, Elad I. Levy, Peter Mitchell, Michael Chen, Joey English, Qaisar A. Shah, Frank L. Silver, Vítor Mendes Pereira, Brijesh Mehta, Blaise Baxter, Michael Abraham, Pedro Cardona, Erol Veznedaroglu, Frank R Hellinger, Lei Feng, Jawad F. Kirmani, Demetrius K. Lopes, Brian T. Jankowitz, Michael Frankel, Vincent Costalat, Nirav Vora, Albert J. Yoo, Amer Malik, Anthony J. Furlan, Marta Rubiera, Amin Aghaebrahim, Jean‐Marc Olivot, Wondwossen Tekle, Ryan Shields, Todd Graves, Roger Lewis, Wade S. Smith, David S. Liebeskind, Jeffrey L. Saver, Tudor G. Jovin · 发表于：New England Journal of Medicine · 年份：2017 · DOI：10.1056/nejmoa1706442 · 被引用次数：5659 · 研究领域：Acute Ischemic Stroke Management、Cerebrovascular and Carotid Artery Diseases、Intracranial Aneurysms: Treatment and Complications

BACKGROUND: The effect of endovascular thrombectomy that is performed more than 6 hours after the onset of ischemic stroke is uncertain. Patients with a clinical deficit that is disproportionately severe relative to the infarct volume may benefit from late thrombectomy. METHODS: We enrolled patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who had last been known to be well 6 to 24 hours earlier and who had a mismatch between the severity of the clinical deficit and the infarct volume, with mismatch criteria defined according to age (<80 years or ≥80 years). Patients were randomly assigned to thrombectomy plus standard care (the thrombectomy group) or to standard care alone (the control group). The coprimary end points were the mean score for disability on the utility-weighted modified Rankin scale (which ranges from 0 [death] to 10 [no symptoms or disability]) and the rate of functional independence (a score of 0, 1, or 2 on the modified Rankin scale, which ranges from 0 to 6, with higher scores indicating more severe disability) at 90 days. RESULTS: A total of 206 patients were enrolled; 107 were assigned to the thrombectomy group and 99 to the control group. At 31 months, enrollment in the trial was stopped because of the results of a prespecified interim analysis. The mean score on the utility-weighted modified Rankin scale at 90 days was 5.5 in the thrombectomy group as compared with 3.4 in the control group (adjusted ...