TY - JOUR
T1 - Endovascular therapy for ischemic stroke with perfusion-imaging selection
AU - Campbell, Bruce Charles Vivian
AU - Mitchell, Peter J
AU - Kleinig, Timothy John
AU - Dewey, Helen M
AU - Churilov, Leonid
AU - Yassi, Nawaf
AU - Yan, Bernard
AU - Dowling, Richard J
AU - Parsons, Mark W
AU - Oxley, Thomas James
AU - Wu, Teddy Y
AU - Brooks, Mark D
AU - Simpson, Marion A
AU - Miteff, Ferdinand
AU - Levi, Christopher Royce
AU - Krause, Martin F
AU - Harrington, Timothy J
AU - Faulder, Kenneth Charles
AU - Steinfort, Brendan S
AU - Priglinger, Miriam
AU - Ang, Timothy E
AU - Scroop, Rebecca
AU - Barber, Peter Alan
AU - McGuinness, Ben J
AU - Wijeratne, Tissa
AU - Phan, Thanh G
AU - Chong, Winston
AU - Chandra, Ronil Vikesh
AU - Bladin, Christopher F
AU - Badve, Monica S
AU - Rice, Henry
AU - de Villiers, Laetitia
AU - Ma, Henry Hin Kui
AU - Desmond, Patricia M
AU - Donnan, Geoffrey
AU - Davis, Stephen M
PY - 2015
Y1 - 2015
N2 - 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
AB - 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
UR - http://www.nejm.org/doi/pdf/10.1056/NEJMoa1414792
U2 - 10.1056/NEJMoa1414792
DO - 10.1056/NEJMoa1414792
M3 - Article
SN - 0028-4793
VL - 372
SP - 1009
EP - 1018
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 11
ER -