Mechanical thrombectomy has been proven to be of benefit when implemented early after ischemic stroke onset. This study compared the efficacy and safety of combined neurovascular thrombectomy and medical therapy with medical therapy alone for patients with acute ischemic stroke.
Eligible patients were18 to 80 years of age with acute ischemic stroke by large proximal vessel occlusion, seen at one of four Spanish treatment centers between November of 2000 and December of 2014. Subjects were seen within eight hours of symptom onset. All demonstrated pre-stroke functional ability of one or less on the modified Rankin Scale (mRS) and baseline scores of six points or more on the National Institute of Health Stroke Scale (NIHSS). The 206 participants were randomized to receive medical reperfusion therapy alone (control group) or to that treatment plus endovascular reperfusion therapy (treatment group). The primary outcome variable was the severity of disability at 90 days, as measured by the mRS.
Improvement in the distribution of the mRS scores favored the thrombectomy group (odds ratio 1.7). The absolute difference in the proportion of patients functionally independent was 15.5% percentage points, favoring the thrombectomy group, with an adjusted odds ratio of 2.1. No significant differences were found between groups in rates of death or symptomatic intracranial hemorrhage. The study was halted prematurely due to a demonstration of a lack of equipoise.
This prospective study of patients with acute ischemic stroke supports the efficacy of endovascular treatment combined with medical treatment.
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Mechanical thrombectomy has been proven to be of benefit when implemented early after ischemic stroke onset. This study compared the efficacy and safety of combined neurovascular thrombectomy and medical therapy with medical therapy alone for patients with acute ischemic stroke.
Eligible patients were18 to 80 years of age with acute ischemic stroke by large proximal vessel occlusion, seen at one of four Spanish treatment centers between November of 2000 and December of 2014. Subjects were seen within eight hours of symptom onset. All demonstrated pre-stroke functional ability of one or less on the modified Rankin Scale (mRS) and baseline scores of six points or more on the National Institute of Health Stroke Scale (NIHSS). The 206 participants were randomized to receive medical reperfusion therapy alone (control group) or to that treatment plus endovascular reperfusion therapy (treatment group). The primary outcome variable was the severity of disability at 90 days, as measured by the mRS.
Improvement in the distribution of the mRS scores favored the thrombectomy group (odds ratio 1.7). The absolute difference in the proportion of patients functionally independent was 15.5% percentage points, favoring the thrombectomy group, with an adjusted odds ratio of 2.1. No significant differences were found between groups in rates of death or symptomatic intracranial hemorrhage. The study was halted prematurely due to a demonstration of a lack of equipoise.
This prospective study of patients with acute ischemic stroke supports the efficacy of endovascular treatment combined with medical treatment.
【摘自：Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Eng J Med. 2015，11；372(24): 2296-2306.】
