Endovascular therapy for ischemic stroke with perfusion-imaging selection

Bruce Charles Vivian Campbell, Peter J Mitchell, Timothy John Kleinig, Helen M Dewey, Leonid Churilov, Nawaf Yassi, Bernard Yan, Richard J Dowling, Mark W Parsons, Thomas James Oxley, Teddy Y Wu, Mark D Brooks, Marion A Simpson, Ferdinand Miteff, Christopher Royce Levi, Martin F Krause, Timothy J Harrington, Kenneth Charles Faulder, Brendan S Steinfort, Miriam PriglingerTimothy E Ang, Rebecca Scroop, Peter Alan Barber, Ben J McGuinness, Tissa Wijeratne, Thanh G Phan, Winston Chong, Ronil Vikesh Chandra, Christopher F Bladin, Monica S Badve, Henry Rice, Laetitia de Villiers, Henry Hin Kui Ma, Patricia M Desmond, Geoffrey Donnan, Stephen M Davis

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2834 Citations (Scopus)

Abstract

Background: Trials of endovascular therapy for ischemic stroke have produced variable results. We conducted this study to test whether more advanced imaging selection, recently developed devices, and earlier intervention improve outcomes. Methods: We randomly assigned patients with ischemic stroke who were receiving 0.9 mg of alteplase per kilogram of body weight less than 4.5 hours after the onset of ischemic stroke either to undergo endovascular thrombectomy with the Solitaire FR (Flow Restoration) stent retriever or to continue receiving alteplase alone. All the patients had occlusion of the internal carotid or middle cerebral artery and evidence of salvageable brain tissue and ischemic core of less than 70 ml on computed tomographic (CT) perfusion imaging. The coprimary outcomes were reperfusion at 24 hours and early neurologic improvement (.8-point reduction on the National Institutes of Health Stroke Scale or a score of 0 or 1 at day 3). Secondary outcomes included the functional score on the modified Rankin scale at 90 days. Results: The trial was stopped early because of efficacy after 70 patients had undergone randomization (35 patients in each group). The percentage of ischemic territory that had undergone reperfusion at 24 hours was greater in the endovascular-therapy group than in the alteplase-only group (median, 100 vs. 37 ; P
Original languageEnglish
Pages (from-to)1009 - 1018
Number of pages10
JournalThe New England Journal of Medicine
Volume372
Issue number11
DOIs
Publication statusPublished - 2015

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