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Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size.
- Source :
-
The New England journal of medicine [N Engl J Med] 2024 May 09; Vol. 390 (18), pp. 1677-1689. - Publication Year :
- 2024
-
Abstract
- Background: The use of thrombectomy in patients with acute stroke and a large infarct of unrestricted size has not been well studied.<br />Methods: We assigned, in a 1:1 ratio, patients with proximal cerebral vessel occlusion in the anterior circulation and a large infarct (as defined by an Alberta Stroke Program Early Computed Tomographic Score of ≤5; values range from 0 to 10) detected on magnetic resonance imaging or computed tomography within 6.5 hours after symptom onset to undergo endovascular thrombectomy and receive medical care (thrombectomy group) or to receive medical care alone (control group). The primary outcome was the score on the modified Rankin scale at 90 days (scores range from 0 to 6, with higher scores indicating greater disability). The primary safety outcome was death from any cause at 90 days, and an ancillary safety outcome was symptomatic intracerebral hemorrhage.<br />Results: A total of 333 patients were assigned to either the thrombectomy group (166 patients) or the control group (167 patients); 9 were excluded from the analysis because of consent withdrawal or legal reasons. The trial was stopped early because results of similar trials favored thrombectomy. Approximately 35% of the patients received thrombolysis therapy. The median modified Rankin scale score at 90 days was 4 in the thrombectomy group and 6 in the control group (generalized odds ratio, 1.63; 95% confidence interval [CI], 1.29 to 2.06; P<0.001). Death from any cause at 90 days occurred in 36.1% of the patients in the thrombectomy group and in 55.5% of those in the control group (adjusted relative risk, 0.65; 95% CI, 0.50 to 0.84), and the percentage of patients with symptomatic intracerebral hemorrhage was 9.6% and 5.7%, respectively (adjusted relative risk, 1.73; 95% CI, 0.78 to 4.68). Eleven procedure-related complications occurred in the thrombectomy group.<br />Conclusions: In patients with acute stroke and a large infarct of unrestricted size, thrombectomy plus medical care resulted in better functional outcomes and lower mortality than medical care alone but led to a higher incidence of symptomatic intracerebral hemorrhage. (Funded by Montpellier University Hospital; LASTE ClinicalTrials.gov number, NCT03811769.).<br /> (Copyright © 2024 Massachusetts Medical Society.)
- Subjects :
- Aged
Aged, 80 and over
Female
Humans
Male
Cerebral Hemorrhage etiology
Combined Modality Therapy
Endovascular Procedures
Magnetic Resonance Imaging
Tomography, X-Ray Computed
Brain Infarction diagnostic imaging
Brain Infarction etiology
Brain Infarction therapy
Acute Disease
Cerebral Arteries diagnostic imaging
Cerebral Arteries surgery
Cerebral Arterial Diseases complications
Cerebral Arterial Diseases diagnostic imaging
Cerebral Arterial Diseases pathology
Cerebral Arterial Diseases surgery
Stroke diagnostic imaging
Stroke etiology
Stroke therapy
Thrombectomy
Thrombolytic Therapy adverse effects
Thrombolytic Therapy methods
Infarction, Anterior Cerebral Artery diagnostic imaging
Infarction, Anterior Cerebral Artery pathology
Infarction, Anterior Cerebral Artery surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1533-4406
- Volume :
- 390
- Issue :
- 18
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 38718358
- Full Text :
- https://doi.org/10.1056/NEJMoa2314063