Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion

作者：Chunrong Tao, Raul G. Nogueira, Yuyou Zhu, Jun Sun, Hongxing Han, Guangxiong Yuan, Changming Wen, Peiyang Zhou, Wenhuo Chen, Guoyong Zeng, Yuwen Li, Zhengfei Ma, Chuanqing Yu, Junfeng Su, Zhiming Zhou, Zhongjun Chen, Geng Liao, Yaxuan Sun, Youquan Ren, Hui Zhang, Jie Chen, Xincan Yue, Guodong Xiao, Li Wang, Rui Liu, Wenhua Liu, Yong Liu, Li Wang, Chao Zhang, Tianlong Liu, Jianlong Song, Rui Li, Pengfei Xu, Yamei Yin, Guoping Wang, Blaise Baxter, Adnan I. Qureshi, Xinfeng Liu, Wei Hu · 发表于：New England Journal of Medicine · 年份：2022 · DOI：10.1056/nejmoa2206317 · 被引用次数：663 · 研究领域：Acute Ischemic Stroke Management、Spatial Neglect and Hemispheric Dysfunction、Cerebrovascular and Carotid Artery Diseases

BACKGROUND: Data from trials investigating the effects and risks of endovascular thrombectomy for the treatment of stroke due to basilar-artery occlusion are limited. METHODS: We conducted a multicenter, prospective, randomized, controlled trial of endovascular thrombectomy for basilar-artery occlusion at 36 centers in China. Patients were assigned, in a 2:1 ratio, within 12 hours after the estimated time of basilar-artery occlusion to receive endovascular thrombectomy or best medical care (control). The primary outcome was good functional status, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]), at 90 days. Secondary outcomes included a modified Rankin scale score of 0 to 2, distribution across the modified Rankin scale score categories, and quality of life. Safety outcomes included symptomatic intracranial hemorrhage at 24 to 72 hours, 90-day mortality, and procedural complications. RESULTS: Of the 507 patients who underwent screening, 340 were in the intention-to-treat population, with 226 assigned to the thrombectomy group and 114 to the control group. Intravenous thrombolysis was used in 31% of the patients in the thrombectomy group and in 34% of those in the control group. Good functional status at 90 days occurred in 104 patients (46%) in the thrombectomy group and in 26 (23%) in the control group (adjusted rate ratio, 2.06; 95% confidence interval [CI], 1.46 to 2.91, P<0.001). Symptomatic intracranial hemorrhage occurred ...