A randomized trial of intraarterial treatment for acute ischemic stroke.

作者：O. Berkhemer, P. Fransen, D. Beumer, L. A. van den Berg, Hester F. Lingsma, A. Yoo, W. Schonewille, J. Vos, P. Nederkoorn, M. Wermer, M. V. van Walderveen, J. Staals, J. Hofmeijer, J. V. van Oostayen, G. J. Lycklama à Nijeholt, J. Boiten, P. Brouwer, B. Emmer, S. D. de Bruijn, Lukas C. van Dijk, L. Kappelle, Rob H. Lo, E. V. van Dijk, J. de Vries, P. D. de Kort, W. van Rooij, J. V. D. van den Berg, B. V. van Hasselt, L. Aerden, R. Dallinga, M. Visser, J. Bot, P. Vroomen, O. Eshghi, T. Schreuder, R. Heijboer, K. Keizer, A. Tielbeek, H. D. den Hertog, D. Gerrits, R. M. Van den Berg-Vos, G. Karas, E. Steyerberg, H. Z. Flach, H. Marquering, M. Sprengers, S. Jenniskens, L. Beenen, R. van den Berg, P. Koudstaal, W. V. van Zwam, Y. Roos, A. van der Lugt, R. V. van Oostenbrugge, C. Majoie, D. Dippel · 发表于：New England Journal of Medicine · 年份：2015 · DOI：10.1056/nejmoa1411587 · 被引用次数：6070 · 研究领域：Medicine

BACKGROUND In patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, intraarterial treatment is highly effective for emergency revascularization. However, proof of a beneficial effect on functional outcome is lacking. METHODS We randomly assigned eligible patients to either intraarterial treatment plus usual care or usual care alone. Eligible patients had a proximal arterial occlusion in the anterior cerebral circulation that was confirmed on vessel imaging and that could be treated intraarterially within 6 hours after symptom onset. The primary outcome was the modified Rankin scale score at 90 days; this categorical scale measures functional outcome, with scores ranging from 0 (no symptoms) to 6 (death). The treatment effect was estimated with ordinal logistic regression as a common odds ratio, adjusted for prespecified prognostic factors. The adjusted common odds ratio measured the likelihood that intraarterial treatment would lead to lower modified Rankin scores, as compared with usual care alone (shift analysis). RESULTS We enrolled 500 patients at 16 medical centers in The Netherlands (233 assigned to intraarterial treatment and 267 to usual care alone). The mean age was 65 years (range, 23 to 96), and 445 patients (89.0%) were treated with intravenous alteplase before randomization. Retrievable stents were used in 190 of the 233 patients (81.5%) assigned to intraarterial treatment. The adjusted common odds ratio was 1.67 (95% confi...