J 2023

Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial

BENDSZUS, Martin, Jens FIEHLER, Fabien SUBTIL, Susanne BONEKAMP, Anne Hege AAMODT et. al.

Základní údaje

Originální název

Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial

Autoři

BENDSZUS, Martin, Jens FIEHLER, Fabien SUBTIL, Susanne BONEKAMP, Anne Hege AAMODT, Blanca FUENTES, Elke R GIZEWSKI, Michael D HILL, Antonin KRAJINA, Laurent PIEROT, Claus Z SIMONSEN, Kamil ZELENAK, Rolf A BLAUENFELDT, Bastian CHENG, Angelique DENIS, Hannes DEUTSCHMANN, Franziska DORN, Fabian FLOTTMANN, Susanne GELLISSEN, Johannes C GERBER, Mayank GOYAL, Jozef HARING, Christian HERWEH, Silke HOPF-JENSEN, Vi Tuan HUA, Maerit JENSEN, Andreas KASTRUP, Christiane Fee KEIL, Andrej KLEPANEC, Egon KURCA, Ronni MIKKELSEN, Markus MOEHLENBRUCH, Stefan MUELLER-HUELSBECK, Nico MUENNICH, Paolo PAGANO, Panagiotis PAPANAGIOTOU, Gabor C PETZOLD, Mirko PHAM, Volker PUETZ, Jan RAUPACH, Gernot REIMANN, Peter Arthur RINGLEB, Maximilian SCHELL, Eckhard SCHLEMM, Silvia SCHOENENBERGER, Bjorn TENNOE, Christian ULFERT, Kateřina VALIŠ (203 Česká republika), Eva VITKOVA, Dominik F VOLLHERBST, Wolfgang WICK a Goetz THOMALLA

Vydání

Lancet, NEW YORK, ELSEVIER SCIENCE INC, 2023, 0140-6736

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30230 Other clinical medicine subjects

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Odkazy

Impakt faktor

Impact factor: 168.900 v roce 2022

Kód RIV

RIV/00216224:90249/23:00131960

Organizační jednotka

CZECRIN IV

UT WoS

001116664800001

Klíčová slova česky

METAANALYSIS; THERAPY; TENSION

Klíčová slova anglicky

METAANALYSIS; THERAPY; TENSION

Příznaky

Mezinárodní význam, Recenzováno
Změněno: 12. 4. 2024 12:59, Mgr. Michal Petr

Anotace

V originále

Background Recent evidence suggests a beneficial effect of endovascular thrombectomy in acute ischaemic stroke with large infarct; however, previous trials have relied on multimodal brain imaging, whereas non-contrast CT is mostly used in clinical practice. Methods In a prospective multicentre, open-label, randomised trial, patients with acute ischaemic stroke due to large vessel occlusion in the anterior circulation and a large established infarct indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) of 3-5 were randomly assigned using a central, web-based system (using a 1:1 ratio) to receive either endovascular thrombectomy with medical treatment or medical treatment (ie, standard of care) alone up to 12 h from stroke onset. The study was conducted in 40 hospitals in Europe and one site in Canada. The primary outcome was functional outcome across the entire range of the modified Rankin Scale at 90 days, assessed by investigators masked to treatment assignment. The primary analysis was done in the intention-to-treat population. Safety endpoints included mortality and rates of symptomatic intracranial haemorrhage and were analysed in the safety population, which included all patients based on the treatment they received. This trial is registered with ClinicalTrials.gov, NCT03094715.Findings From July 17, 2018, to Feb 21, 2023, 253 patients were randomly assigned, with 125 patients assigned to endovascular thrombectomy and 128 to medical treatment alone. The trial was stopped early for efficacy after the first pre-planned interim analysis. At 90 days, endovascular thrombectomy was associated with a shift in the distribution of scores on the modified Rankin Scale towards better outcome (adjusted common OR 2 center dot 58 [95% CI 1 center dot 60-4 center dot 15]; p=0 center dot 0001) and with lower mortality (hazard ratio 0 center dot 67 [95% CI 0 center dot 46-0 center dot 98]; p=0 center dot 038). Symptomatic intracranial haemorrhage occurred in seven (6%) patients with thrombectomy and in six (5%) with medical treatment alone.Interpretation Endovascular thrombectomy was associated with improved functional outcome and lower mortality in patients with acute ischaemic stroke from large vessel occlusion with established large infarct in a setting using non-contrast CT as the predominant imaging modality for patient selection.

Návaznosti

90249, velká výzkumná infrastruktura
Název: CZECRIN IV