Outcomes of Endovascular Thrombectomy vs Medical Management Alone in Patients With Large Ischemic Cores

作者：Amrou Sarraj, Ameer E Hassan, Sean Isaac Savitz, Clark W. Sitton, James Charles Grotta, Peng Chen, Chunyan C. Cai, Gary Cutter, Bita Imam, Sujan Teegala Reddy, Kaushik Parsha, Deep Kiritbhai Pujara, Roy Riascos, Nirav A. Vora, Michael G. Abraham, Haris Kamal, Diogo C Haussen, Andrew David Barreto, Maarten G. Lansberg, Rishi G. Gupta, Gregory W. Albers · 发表于：JAMA Neurology · 年份：2019 · DOI：10.1001/jamaneurol.2019.2109 · 被引用次数：189 · 研究领域：Acute Ischemic Stroke Management、Cerebrovascular and Carotid Artery Diseases、Stroke Rehabilitation and Recovery

IMPORTANCE: The efficacy and safety of endovascular thrombectomy (EVT) in patients with large ischemic cores remains unknown, to our knowledge. OBJECTIVE: To compare outcomes in patients with large ischemic cores treated with EVT and medical management vs medical management alone. DESIGN, SETTING, AND PARTICIPANTS: This prespecified analysis of the Optimizing Patient's Selection for Endovascular Treatment in Acute Ischemic Stroke (SELECT) trial, a prospective cohort study of imaging selection that was conducted in 9 US comprehensive stroke centers, enrolled patients between January 2016 and February 2018, and followed them up for 90 days. Patients with moderate to severe stroke and anterior circulation large-vessel occlusion presenting up to 24 hours from the time they were last known to be well were eligible for the cohort. Of these, patients with large ischemic cores on computed tomography (CT) (Alberta Stroke Program Early CT Score <6) or CT perfusion scanning (a volume with a relative cerebral blood flow <30% of ≥50 cm3) were included in analyses. EXPOSURES: Endovascular thrombectomy with medical management (MM) or MM only. MAIN OUTCOMES AND MEASURES: Functional outcomes at 90 days per modified Rankin scale; safety outcomes (mortality, symptomatic intracerebral hemorrhage, and neurological worsening). RESULTS: A total of 105 patients with large ischemic cores on either CT or CT perfusion images were included: 71 with Alberta Stroke Program Early CT Scores of 5 or less (EV...