Thrombectomy for Stroke With Large Infarct on Noncontrast CT

作者：Rhonda White, Kerry Gembreska, Varun Chaubal, Mohammad Almajali, Yazan Ashouri, Jasmine M. Olvany, Laila A. Ibrahim, Michael Previti, Shannon Huffaker, Dione Froman, Peter A. Balousek, Bridget Gatscher, Amy K. Erickson, Laura Nguyen, Teji Dulai, Gustavo Rodríguez, Faheem Sheriff, Zeguang Ren, Waldo R. Guerrero, Kunal Vakharia, Anjan Ballekere, Rania Abdelkhaleq, Ananya Iyyangar, Hussain Azeem, Michael Nahhas, Ashutosh Mahapatra, Raquel Rulloda, Rami Z. Morsi, Sonam Thind, Ali Mansour, Harrison Lee, S Calhoun, Misty L Burns, K.N. Murali, Kenneth Liu, Kathleen Gross, Lynn Perez, Nabil B. Ghazal, Katharine Gross, Danielle Otis, Tatiana Burkholder, Kelly Torres, Lisa Carolan-Katz, Timothy Carew, T W Pyle, Anita Buitenwerf, Courtney VanderBroek, Julie A. Harning, Christine A Holmstedt, Ghada Mohamed, Kimberly Kicielinski, Jonathan Lena, Shelly Ozark, Chirantan Banerjee, Parneet Grewal, Ashley Wabnitz, Richard Libman, Henry H. Woo, Ina Teron Molina, Erin Schwartz, Alicia Dee, Sandra Anghel, Daphne Batanero, Thomas Scicutella, Rohan Arora, Christina Kelly, Gaurav Kapoor, Thomas W. Link, Prateeka Koul, Siddharth Dalal, Ahmad A. Ballout, Kirendra Pasram, Emma Lao, Charell Brinkley, Richard Dima, Sabah Iqbal, Parita Bhuva, Paul Hansen, Jazba Soomro, Osman Mir, Norman Ajoboye, Christian Cajavilca, Charoskhon Turabova, Imran Farooqui, Mary-Ann Fares, Kevin Yeboah, Jonathan Greco, Jessica Whitis, Sowmya R. Rao, Peggy Vo, Lametria West, Jing Lu, Pauline Matheri, Rocio Sauder, B T Jackson, Scott L Paradise, Shonda Clark, Charles R. Hughes, Yong H. Park, Joseph J. Park, Sabeen Dhand, Paul O’Connor, Margaret Gaston, Stephanie M. Raygoza, Krystal Valdez, Priyank Khandelwal, Pradeep Joseph, Roxanne Nagurka, Shashvat M. Desai, Enrique C. Leira, Amir Shaban, Malik Ghannam, Hannah Roeder, Heena Olalde, K Dlouhy, Colin P. Derdeyn, Minako Hayaawa, Siddhart Mehta, Farah Fourcand, Abdallah Amireh, Haralabos Zacharatos, Vimla Parboji, Harish Shownkeen, Avi Mazumdar, B Fill, Eva Chwastowska, Izabela Holanday, Rosemarie R. Baligod, Jennifer Schmidt, SoHyun Boo, Abdul Tarabishy, Phong Vu, Ryan C Turner, Michael Czaplicki, Jennifer Domico, Paramjot Kaur, Vasu Saini, Joshua Burks Burks, Joshua Abecassis, Guillermo Linares, Jay Vanchhani, Paul M. Foreman, Charlene Carlo, Melanie B. Pakulski, Diane L. Philip, Richard Burgess, Vieh Kung, Julie Shawver, Melinda Hendricks‐Jones, Monica M. Hajjar, Sarah Robbins, Emily Sedlak, Trisha Dwyer, Christopher Crayne, Rahul Rao, Swayamprava Panda, Sherry L Mosier, Jasmeet Singh, Elad I. Levy, Jason M. Davies, Kenneth V. Snyder, Scott Brown, Thanh N. Nguyen, Daryl R. Gress, Diederik W.J. Dippel, Wade S. Smith, Ziad Darkhabani, Sudeepta Dandapat, Kindy Szarzynski, Batul Dhariwala, Tonya Hollrith, Laura Thoreson, Margaret Scott, V Kerr, Gursant Atwal, Linda Rose‐Finnell, Christine Maley, Madhav Sukhumaran, Babak S. Jahromi, Donald R. Cantrell, R Abdalla, Matthew B. Potts, Ali Shaibani, Ayesha Muzaffar, Esmeralda Cardoso-Mendoza, Vivek Reddy, Peter Hannon, Lee Chung, Peter Tekiela, Knut Hoversten, Dana DeWitt, Jana Wold, Craig Kilburg, Phil Taussky, Matthew R. Alexander, David Renner, Muhammed Chauhan, Safdar Ansari, Tom Ross, Pankaj Sharma, Junaid Ansari, Luis DeAlba, Nimer Adeeb, Amey Savardekar, Roger Kelly, Oleg Chernyshev, Kimberly Carroll, Nathaniel Glassy, Scott Geraghty, Diana Sullivan, Mira Pasawala, April Levesque, Laura Atkin, Emma Hall, Elida Romo, Mahmoud Rayes, Bharath Naravetla, Jonathan Stearn, Valentyna Onishchuk, E. Mary Thompson, Marci Roberts, Amit Singla, Volodymyr Vulkanov, Esther A. Nimchinsky, Arundhati Biswas, A. Hidalgo, Nora Montealegre, Yesenia Sanchez, Anastasia Vechera, Nicole Mercado, Jennifer Unzen, Ahmad Khaldi, Chris Horn, Kumiko Owada, Raisa C. Martínez, Ugo Nwosu, Erica Ononiwu, Janhavi Modak, Kasey B. Grimmett, Sharon Aureli, Sandy Mitchell, J. Gordon Boak, Lonna Blaske, Vivien Lee, Ciarán J. Powers, Shahid Minjee, Patrick Youssef, Weiping Ye, Mohammad Hamed, Luke Herren, Albert J. Yoo, Osama O. Zaidat, Sunil G. Sheth, Ansaar Rai, Santiago Ortega-Gutierrez, Curtis A. Given, Syed Hassan Ejaz Zaidi, Ramesh Grandhi, Hugo Cuellar, Maxim Mokin, Jeffrey M. Katz, Amer Alshekhlee, Muhammad Taqi, Sameer A. Ansari, Adnan H. Siddiqui, Nobl Barazangi, Joey English, Alberto Maud, Jawad F. Kirmani, Rishi Gupta, Dileep R. Yavagal, Jason Tarpley, Dhruvil J. Pandya, Marshall C. Cress, Sushrut Dharmadhikari, Kaiz Asif, Tareq Kass‐Hout, Ajit S. Puri, Nazli Janjua, Aniel Majjhoo, Aamir Badruddin, Randall C. Edgell, Rakesh Khatri, Larry Morgan, Anmar Razak, Alicia Zha, Priyank Khandelwal, Nils Mueller‐Kronast, Dennis J. Rivet, Thomas W. Wolfe, Brian Snelling, Ali Sultan‐Qurraie, Shao‐Pow Lin, Rajkamal Khangura, Alejandro M Spiotta, Parita Bhuva, Sergio Salazar-Marioni, Eugene Lin, Abdul Tarabishy, Edgar A. Samaniego, Murali Kolikonda, Mouhammad Jumaa, Vivek K. Reddy, Pankaj Sharma, Olvert A. Berkhemer, Pieter‐Jan van Doormaal, Adriaan C.G.M. van Es, Wim H. van Zwam, Bart J. Emmer, Ludo F.M. Beenen, Charles B.L.M. Majoie, Nancy Buderer, Michelle A. Detry, Anna Bosse, Todd Graves, Christina Saunders, Lucas Elijovich, Ashutosh P. Jadhav, Mary Patterson, Hannah Slight, Kristine Below, Sami Al Kasab, TESLA Investigators · 发表于：JAMA · 年份：2024 · DOI：10.1001/jama.2024.13933 · 被引用次数：136 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Venous Thromboembolism Diagnosis and Management

Importance: Recent large infarct thrombectomy trials used heterogeneous imaging modalities and time windows for patient selection. Noncontrast computed tomographic (CT) scan is the most common stroke imaging approach. It remains uncertain whether thrombectomy is effective for patients with large infarcts identified using noncontrast CT alone within 24 hours of stroke onset. Objective: To evaluate the effect of thrombectomy in patients with a large infarct on a noncontrast CT scan within 24 hours of onset. Design, Setting, and Participants: Open-label, blinded-end point, bayesian-adaptive randomized trial with interim analyses for early stopping (futility or success) or population enrichment, which was conducted at 47 US academic and community-based stroke thrombectomy centers. Three hundred patients presenting within 24 hours with anterior-circulation, large-vessel occlusion and large infarct on noncontrast CT scan, with Alberta Stroke Program Early CT Scores of 2 to 5, were randomized to undergo thrombectomy or usual care. Enrollment occurred July 16, 2019 to October 17, 2022; final follow-up, January 25, 2023. Intervention: The intervention patients (n = 152) underwent endovascular treatment using standard thrombectomy devices and usual medical care. Control patients (n = 148) underwent usual medical care alone. Main Outcomes and Measures: The primary efficacy end point was improvement in 90-day functional outcome measured using mean utility-weighted modified Rankin Scale (...