Endovascular Treatment of Medium-Vessel-Occlusion Strokes

作者：Wei Hu, Xiaozhong Jing, Z J Chen, Jin Zheng, Tingyu Yi, Tuanyuan Zheng, Z H Li, Junzhong Liu, Tao Cui, Jianshang Wen, Ganghua Feng, Cunfeng Song, Lei Yang, Shunfu Jiang, Lin Tong, Changchun Jiang, Zhongfan Ruan, ˒Peiyang Zhou, Shouchun Wang, Tao Wang, Zhiming Zhou, Youquan Ren, Tao Qiu, Chong Zheng, Hao Wang, Yong Liu, Yun Luo, Yi-Xiang Wang, Zhengfei Ma, Bin Mei, Yong Liang, Y C Zhu, R K Li, J F Sun, Li Wang, Chao Zhang, T Liu, Jianlong Song, Chunrong Tao, Anmo Wang, Yi-Xiang Wang, Pengfei Xu, Xiaofan Guo, Liqi Shu, Adnan I. Qureshi, Thanh N. Nguyen, Mohamad AbdalKader, Jeffrey L. Saver, Wenhuo Chen, Raul G. Nogueira · 发表于：New England Journal of Medicine · 年份：2026 · DOI：10.1056/nejmoa2514120 · 被引用次数：20 · 研究领域：Acute Ischemic Stroke Management、Peripheral Artery Disease Management、Cerebrovascular and Carotid Artery Diseases

BACKGROUND: Endovascular thrombectomy for acute ischemic stroke due to medium-vessel occlusion has had varying results across trials. Whether thrombectomy improves functional outcomes in patients with medium-vessel occlusion and moderate-to-severe deficits is unclear. METHODS: We conducted an open-label, randomized trial with blinded outcome assessment at 48 centers in China. Eligible patients were adults who presented within 24 hours after the onset of a moderate-to-severe stroke (National Institutes of Health Stroke Scale [NIHSS] score, ≥6; scale, 0 to 42, with higher scores indicating greater neurologic deficits) due to occlusion of a medium vessel. Patients were assigned in a 1:1 ratio to thrombectomy plus medical management (thrombectomy group) or medical management alone (control group). The primary outcome was functional disability as measured by the shift in the modified Rankin scale score (scale, 0 [no disability] to 6 [death]) at 90 days. Violation of the proportional-odds assumption precluded the use of shift in the modified Rankin scale score, so as prespecified, functional independence (modified Rankin scale score of 0, 1, or 2) at 90 days was used as the primary outcome. Safety outcomes were symptomatic intracranial hemorrhage and 90-day mortality. RESULTS: Among 280 patients in the thrombectomy group and 283 in the control group, the median age was 71 years, the median NIHSS score was 10 (range, 3 to 36), and 42.8% were women; 36.6% received intravenous thrombo...