Trial of Endovascular Thrombectomy for Large Ischemic Strokes

作者：Amrou Sarraj, Ameer E Hassan, Michael G. Abraham, Santiago Ortega‐Gutiérrez, Scott Eric Kasner, Muhammad Shazam Hussain, Michael Chen, Spiros Blackburn, Clark W. Sitton, Leonid P. Churilov, Sophia Sundararajan, Yin Chun Hu, Nabeel A. Herial, Pascal M. Jabbour, Daniel P. Gibson, Adam N. Wallace, Juan Francisco Arenillas, Jenny Peih-Chir Tsai, Ronald F. Budzik, William J. Hicks, Osman Samil Kozak, Bernard Yan, Dennis John Cordato, Nathan W. Manning, Mark William Parsons, Ricardó A. Hanel, Amin N. Aghaebrahim, Teddy Y. Wu, Pere Cardona-Portela, Natàlia Pérez de la Ossa, Joanna Danielle Schaafsma, Jordi Blasco, Navdeep S Sangha, Steven J. Warach, Chirag D. Gandhi, Timothy John Kleinig, Daniel H. Sahlein, Lucas Elijovich, Wondwossen G. Tekle, Edgar Andres Samaniego, Laith N Maali, Mohammad A Abdulrazzak, Marios N. Psychogios, Ashfaq M Shuaib, Deep Kiritbhai Pujara, Faris Shaker, Hannah Tabitha Johns, Gagan Jyoti Sharma, Vignan Yogendrakumar, Felix Ng, Mohammad H Rahbar, Chunyan C. Cai, Philip William Lavori, Scott A. Hamilton, Thanh N. Nguyen, Johanna T Fifi, Stephen M. Davis, Lawrence R. Wechsler, Vítor Mendes Pereira, Maarten G. Lansberg, Michael D. Hill, James Charles Grotta, Marc Ribó, Bruce C.V. Campbell, Gregory W. Albers · 发表于：New England Journal of Medicine · 年份：2023 · DOI：10.1056/nejmoa2214403 · 被引用次数：921 · 研究领域：Acute Ischemic Stroke Management、Intracranial Aneurysms: Treatment and Complications、Cerebrovascular and Carotid Artery Diseases

BACKGROUND: Trials of the efficacy and safety of endovascular thrombectomy in patients with large ischemic strokes have been carried out in limited populations. METHODS: We performed a prospective, randomized, open-label, adaptive, international trial involving patients with stroke due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery to assess endovascular thrombectomy within 24 hours after onset. Patients had a large ischemic-core volume, defined as an Alberta Stroke Program Early Computed Tomography Score of 3 to 5 (range, 0 to 10, with lower scores indicating larger infarction) or a core volume of at least 50 ml on computed tomography perfusion or diffusion-weighted magnetic resonance imaging. Patients were assigned in a 1:1 ratio to endovascular thrombectomy plus medical care or to medical care alone. The primary outcome was the modified Rankin scale score at 90 days (range, 0 to 6, with higher scores indicating greater disability). Functional independence was a secondary outcome. RESULTS: The trial was stopped early for efficacy; 178 patients had been assigned to the thrombectomy group and 174 to the medical-care group. The generalized odds ratio for a shift in the distribution of modified Rankin scale scores toward better outcomes in favor of thrombectomy was 1.51 (95% confidence interval [CI], 1.20 to 1.89; P<0.001). A total of 20% of the patients in the thrombectomy group and 7% in the medical-care group had functional ind...