Thrombectomy versus Medical Management in Mild Strokes due to Large Vessel Occlusion: Exploratory Analysis from the EXTEND‐IA Trials and a Pooled International Cohort

作者：Amrou Sarraj, Gregory W. Albers, Jordi Blasco, Juan F. Arenillas, Marc Ribó, Ameer E Hassan, Natàlia Pérez de la Ossa, Teddy Y. Wu, Pere Cardona Portela, Michael Abraham, Michael Chen, Laith Maali, Timothy Kleinig, Dennis Cordato, Adam N. Wallace, Joanna D. Schaafsma, Navdeep Sangha, Daniel Gibson, Spiros Blackburn, Mercedes de Lera Alfonso, Deep Pujara, Faris Shaker, Margy McCullough‐Hicks, Javier Moreno, Arturo Renú, James Beharry, Cecilia Cappelen‐Smith, Luis Rodríguez‐Esparragoza, Marta Olivé‐Gadea, Manuel Requena, Tareq S Almaghrabi, Vítor Mendes Pereira, Clark Sitton, Sheryl Martin‐Schild, Sarah Song, Henry Ma, Leonid Churilov, Peter Mitchell, Mark Parsons, Anthony J. Furlan, James C. Grotta, Geoffrey A. Donnan, Stephen M. Davis, Bruce Campbell, for the PERFECT‐MILD Collaborators · 发表于：Annals of Neurology · 年份：2022 · DOI：10.1002/ana.26418 · 被引用次数：40 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Venous Thromboembolism Diagnosis and Management

Objective This study was undertaken to evaluate functional and safety outcomes for endovascular thrombectomy (EVT) versus medical management (MM) in patients with large vessel occlusion (LVO) and mild neurological deficits, stratified by perfusion imaging mismatch. Methods The pooled cohort consisted of patients with National Institutes of Health Stroke Scale (NIHSS) < 6 and internal carotid artery (ICA), M1, or M2 occlusions from the Extending the Time for Thrombolysis in Emergecy Neurological Deficits ‐ Intra‐Arterial (EXTEND‐IA) Trial, Tenecteplase vs Alteplase before Endovascular Thrombectomy in Ischemic Stroke (EXTEND‐IA TNK) trials Part I/II and prospective data from 15 EVT centers from October 2010 to April 2020. RAPID software estimated ischemic core and mismatch. Patients receiving primary EVT (EVT pri ) were compared to those who received primary MM (MM pri ), including those who deteriorated and received rescue EVT, in overall and propensity score (PS)‐matched cohorts. Patients were stratified by target mismatch (mismatch ratio ≥ 1.8 and mismatch volume ≥ 15ml). Primary outcome was functional independence (90‐day modified Rankin Scale = 0–2). Secondary outcomes included safety (symptomatic intracerebral hemorrhage [sICH], neurological worsening, and mortality). Results Of 540 patients, 286 (53%) received EVT pri and demonstrated larger critically hypoperfused tissue (Tmax > 6 seconds) volumes (median [IQR]: 64 [26–96] ml vs MM pri : 40 [14–76] ml, p < 0.00...