Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels

被引：25

作者：

Psychogios, Marios ^{[1
,2
]}

Brehm, Alex ^{[1
]}

Ribo, Marc ^{[3
,4
]}

Rizzo, Federica ^{[3
,4
]}

Strbian, Daniel ^{[5
]}

Raety, Silja ^{[5
]}

Arenillas, Juan F. ^{[6
,7
]}

Martinez-Galdamez, Mario ^{[8
]}

Hajdu, Steven D. ^{[9
]}

Michel, Patrik ^{[10
]}

Gralla, Jan ^{[11
]}

Piechowiak, Eike I. ^{[11
]}

Kaiser, Daniel P. O. ^{[12
,13
]}

Puetz, Volker ^{[13
,14
]}

van den Bergh, Frans ^{[15
]}

De Raedt, Sylvie ^{[16
]}

Bellante, Flavio ^{[17
]}

Dusart, Anne ^{[17
]}

Hellstern, Victoria ^{[18
]}

Khanafer, Ali ^{[18
]}

Parrilla, Guillermo ^{[19
]}

Morales, Ana ^{[19
]}

Kirschke, Jan S. ^{[20
]}

Wunderlich, Silke ^{[21
]}

Fiehler, Jens ^{[22
]}

Thomalla, Goetz ^{[23
]}

Lemmens, Robin ^{[24
]}

Peluso, Jo P. ^{[25
]}

Bolognese, Manuel ^{[26
]}

von Hessling, Alexander ^{[27
]}

van Es, Adriaan ^{[28
]}

Kruyt, Nyika D. ^{[29
]}

Coutinho, Jonathan M. ^{[30
]}

Castano, Carlos ^{[31
]}

Minnerup, Jens ^{[32
,33
]}

van Zwam, Wim ^{[34
]}

Dhondt, Elisabeth ^{[35
]}

Nolte, Christian H. ^{[36
]}

Machi, Paolo ^{[37
]}

Loehr, Christian ^{[38
]}

Mattle, Heinrich P. ^{[39
]}

Buhk, Jan-Hendrik ^{[40
]}

Kaesmacher, Johannes ^{[11
,41
]}

Dobrocky, Tomas ^{[11
]}

Papanagiotou, Panagiotis ^{[42
,43
]}

Alonso, Angelika ^{[44
]}

Holtmannspoetter, Markus ^{[45
]}

Zini, Andrea ^{[46
]}

Renieri, Leonardo ^{[47
]}

Keil, Fee ^{[48
]}

机构：

[1] Univ Basel Hosp, Dept Diagnost & Intervent Neuroradiol, Petersgraben 4, CH-4031 Basel, Switzerland

[2] Univ Basel, Basel, Switzerland

[3] Univ Hosp Vall Dhebron, Dept Neurol, Barcelona, Spain

[4] Univ Autonoma Barcelona, Barcelona, Spain

[5] Univ Helsinki, Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland

[6] Univ Valladolid, Hosp Clin Univ, Dept Neurol, Stroke Program, Valladolid, Spain

[7] Univ Clin Hosp Valladolid, Dept Neurol, Stroke Program, Valladolid, Spain

[8] Hosp Clin Univ Valladolid, Intervent Neuroradiol Unit, Dept Radiol, Valladolid, Spain

[9] Ctr Hospitalier Univ Vaudois CHUV, Oncol Dept, Lausanne, Switzerland

[10] Ctr Hospitalier Univ Vaudois CHUV, Oncol Dept, Lausanne, Switzerland

[11] Bern Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Inselspital, Bern, Switzerland

[12] Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Inst Neuroradiol, D-01307 Dresden, Germany

[13] Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Dresden Neurovasc Ctr, Neuroradiol, Dresden, Germany

[14] Tech Univ Dresden, Univ Hosp, Fac Med Carl Gustav Carus, Dept Neurol, Dresden, Germany

[15] Universitair Ziekenhuis Brussel UZ Brussel, Microbiol Dept, B-1090 Brussels, Belgium

[16] Universitair Ziekenhuis Brussel UZ Brussel, Vrije Univ Brussel VUB, Nephrol Dept, Brussels, Belgium

[17] Hop Civil Marie Curie, CHU Charleroi Site, Dept Neurol Surg, Charleroi, Belgium

[18] Klinikum Stuttgart, Dept Neuroradiol, Stuttgart, Germany

[19] Virgen Arrixaca Univ Hosp, Dept Neurol, ES-30100 Murcia, Spain

[20] Tech Univ Munich, Sch Med & Hlth, Dept Diagnost & Intervent Neuroradiol, Klinikum Rechts Isar, D-81675 Munich, Germany

[21] Tech Univ Munich, Sch Med & Hlth, Dept Neurol, Klinikum Rechts Isar, Munich, Germany

[22] Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany

[23] Univ Med Ctr Hamburg Eppendorf, Dept Neurol, Hamburg, Germany

[24] Univ Leuven, KU Leuven, Dept Neurosci, Dept Microbiol & Immunol,Expt Neurol, Leuven, Belgium

[25] Univ Hosp Leuven, Dept Intervent Neuroradiol, Leuven, Belgium

[26] Cantonal Hosp Lucerne, Luzern, Switzerland

[27] Cantonal Hosp Lucerne, Sect Neuroradiol, Luzern, Switzerland

[28] Leiden Univ, Dept Immunohematol & Blood Transfus, Med Ctr, The Hague, Netherlands

[29] Univ NeuroVasc Ctr, Leiden The Hague, Netherlands

[30] Univ Amsterdam, Dept Neurol, Amsterdam Univ Med Ctr, Amsterdam Neurosci, Amsterdam, Netherlands

[31] Hosp Univ Germans Trias I Pujol, Dept Gynecol & Obstet, Badalona, Spain

[32] Univ Munster, Dept Neurol, Munster, Germany

[33] Univ Lubeck, Dept Neurol, Lubeck, Germany

[34] Maastricht Univ, Med Ctr, Dept Radiol & Nucl Med, Maastricht, Netherlands

[35] Ghent Univ Hosp, Dept Anaesthesiol, Ghent, Belgium

[36] Charite, Ctr Stroke Res Berlin, Dept Neurol & Expt Neurol, D-10117 Berlin, Germany

[37] Geneva Univ Hosp, Div Diagnost & Intervent Neuroradiol, Geneva, Switzerland

[38] Klinikum Vest, Dept Neuroradiol, Recklinghausen, Germany

[39] Univ Bern, Bern Univ Hosp, Dept Neurol, Inselspital, Bern, Switzerland

[40] Asklepios Hosp St Georg & Wandsbek, Dept Neuroradiol, Hamburg, Germany

[41] Univ Hosp Ctr Tours, CIC Inserm 1415, Ctr Invest Clin Innovat Technol, Tours, France

[42] Hosp Bremen Mitte, Dept Diagnost & Intervent Neuroradiol, Bremen, Germany

[43] Natl & Kapodistrian Univ Athens, Arete Univ Hosp, Dept Radiol, Athens, Greece

[44] Heidelberg Univ, Univ Med Ctr Mannheim, Dept Neurol, Mannheim, Germany

[45] Nuremberg Hosp Campus South, Intervent & Diagnost Neuroradiol, Nurnberg, Germany

[46] Maggiore Hosp, IRCCS Ist Sci Neurolog Bologna, Neuroradiol Unit, Bologna, Italy

[47] Careggi Univ Hosp, Intervent Neurovasc Unit, Florence, Italy

[48] Goethe Univ, Univ Hosp Frankfurt, Inst Neuroradiol, Frankfurt, Germany

[49] Haaglanden Med Ctr, Dept Neurol, The Haag, Netherlands

[50] Kantonsspital St Gallen, Dept Neurol, St Gallen, Switzerland

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2025年 / 392卷 / 14期

关键词：

ACUTE ISCHEMIC-STROKE; THROMBECTOMY; TRIAL;

D O I：

10.1056/NEJMoa2408954

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Endovascular treatment (EVT) of stroke with large-vessel occlusion is known to be safe and effective. The effect of EVT for occlusion of medium or distal vessels is unclear. Methods We randomly assigned participants with an isolated occlusion of medium or distal vessels (occlusion of the nondominant or codominant M2 segment of the middle cerebral artery [MCA]; the M3 or M4 segment of the MCA; the A1, A2, or A3 segment of the anterior cerebral artery; or the P1, P2, or P3 segment of the posterior cerebral artery) to receive EVT plus best medical treatment or best medical treatment alone within 24 hours after the participant was last seen to be well. The primary outcome was the level of disability at 90 days, as assessed with the modified Rankin scale score. Results A total of 543 participants (women, 44%; median age, 77 years) were included in the analysis: 271 were assigned to receive EVT plus best medical treatment and 272 to receive best medical treatment alone. The median score on the National Institutes of Health Stroke Scale (range, 0 to 42, with higher scores indicating more severe symptoms) at admission was 6 (interquartile range, 5 to 9). Intravenous thrombolysis was given to 65.4% of the participants. The predominant occlusion locations were the M2 segment (in 44.0% of the participants), M3 segment (in 26.9%), P2 segment (in 13.4%), and P1 segment (in 5.5%). In the comparison between EVT plus best medical treatment and best medical treatment alone, no significant difference in the distribution of modified Rankin scale scores was observed at 90 days (common odds ratio for improvement in the score, 0.90; 95% confidence interval, 0.67 to 1.22; P=0.50). All-cause mortality was similar in the two groups (15.5% with EVT plus best medical treatment and 14.0% with best medical treatment alone), as was the incidence of symptomatic intracranial hemorrhage (5.9% and 2.6%, respectively). Conclusions In persons with stroke with occlusion of medium or distal vessels, EVT did not result in a lower level of disability or a lower incidence of death than best medical treatment alone.

引用

页码：1374 / 1384

页数：11

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