A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke

Autor: Berkhemer, O.A., Fransen, P.S.S., Beumer, D., Berg, L.A. van den, Lingsma, H.F., Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Oostayen, J.A. van, Nijeholt, G.J.L.A., Boiten, J., Brouwer, P.A., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., R.H. lo, Dijk, E.J. van, Vries, J. de, Kort, P.L.M. de, Rooij, W.J.J. van, Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Visser, M.C., Bot, J.C.J., Vroomen, P.C., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Steyerberg, E.W., Flach, H.Z., Marquering, H.A., Sprengers, M.E.S., Jenniskens, S.F.M., Beenen, L.F.M., Berg, R. van den, Koudstaal, P.J., Zwam, W.H. van, Roos, Y.B.W.E.M., Lugt, A. van der, Oostenbrugge, R.J. van, Majoie, C.B.L.M., Dippel, D.W.J., MR CLEAN Investigators
Přispěvatelé: Clinical Neurophysiology, Faculty of Science and Technology, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Radiology and Nuclear Medicine, Graduate School, Neurology, Biomedical Engineering and Physics, Other Research, Other departments, Radiology and nuclear medicine, NCA - neurodegeneration, Public Health, Radiology & Nuclear Medicine, RS: CARIM - R3 - Vascular biology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA AIOS Neurologie (9), Interne Geneeskunde, Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: MA Arts Assistenten Obstetrie Gynaecologie (9), Huisartsgeneeskunde, NUTRIM, MUMC+: DA BV Medisch Specialisten Radiologie (9)
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Zdroj: New England Journal of Medicine, 372(1), 11-20. MASSACHUSETTS MEDICAL SOC
New England journal of medicine, 372(1), 11-20. Massachussetts Medical Society
New England Journal of Medicine, 372(1), 11-20
Berkhemer, O A, Fransen, P S S, Beumer, D, van den Berg, L A, Lingsma, H F, Yoo, A J, Schonewille, W J, Vos, J A, Nederkoorn, P J, Wermer, M J H, van Walderveen, M A A, Staals, J, Hofmeijer, J, van Oostayen, J A, Nijeholt, G J L A, Boiten, J, Brouwer, P A, Emmer, B J, de Bruijn, S F, van Dijk, L C, Kappelle, L J, Lo, R H, van Dijk, E J, de Vries, J, de Kort, P L M, van Rooij, W J J, van den Berg, J S P, van Hasselt, B A A M, Aerden, L A M, Dallinga, R J, Visser, M C, Bot, J C J, Vroomen, P C, Eshghi, O, Schreuder, T H C M, Heijboer, R J J, Keizer, K, Tielbeek, A V, den Hertog, H M, Gerrits, D G, Van den Berg-Vos, R, Karas, G B, Steyerberg, E W, Flach, H Z, Marquering, H A, Sprengers, M E S, Jenniskens, S F M, Beenen, L F M, van de Berg, R, Koudstaal, P J, van Zwam, W H, Roos, Y B W E, van der Lugt, A, van Oostenbrugge, R J, Majoie, C B L M & Dippel, D W J 2015, ' A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke ', New England Journal of Medicine, vol. 372, no. 1, pp. 11-20 . https://doi.org/10.1056/NEJMoa1411587
New England Journal of Medicine, 372(1), 11-20. Massachussetts Medical Society
The New England Journal of Medicine, 372, 1, pp. 11-20
New England Journal of Medicine, 372(1), 11-20. MASSACHUSETTS MEDICAL SOCIETY
The New England Journal of Medicine, 372, 11-20
ISSN: 0028-4793
DOI: 10.1056/nejmoa1411587
Popis: Contains fulltext : 153000.pdf (Publisher’s version ) (Open Access) 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% confidence interval [CI], 1.21 to 2.30). There was an absolute difference of 13.5 percentage points (95% CI, 5.9 to 21.2) in the rate of functional independence (modified Rankin score, 0 to 2) in favor of the intervention (32.6% vs. 19.1%). There were no significant differences in mortality or the occurrence of symptomatic intracerebral hemorrhage. CONCLUSIONS: In patients with acute ischemic stroke caused by a proximal intracranial occlusion of the anterior circulation, intraarterial treatment administered within 6 hours after stroke onset was effective and safe. (Funded by the Dutch Heart Foundation and others; MR CLEAN Netherlands Trial Registry number, NTR1804, and Current Controlled Trials number, ISRCTN10888758.).
Databáze: OpenAIRE
Externí odkaz: