Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke

被引：4078

作者：

Saver, Jeffrey L. ^{[1
,2
]}

Goyal, Mayank ^{[5
,6
]}

Bonafe, Alain ^{[10
]}

Diener, Hans-Christoph ^{[12
]}

Levy, Elad I. ^{[17
]}

Pereira, Vitor M. ^{[7
,8
,9
]}

Albers, Gregory W. ^{[4
]}

Cognard, Christophe ^{[11
]}

Cohen, David J. ^{[19
,20
]}

Hacke, Werner ^{[13
]}

Jansen, Olav ^{[14
]}

Jovin, Tudor G. ^{[21
]}

Mattle, Heinrich P. ^{[22
]}

Nogueira, Raul G. ^{[23
]}

Siddiqui, Adnan H. ^{[17
,18
]}

Yavagal, Dileep R. ^{[24
]}

Baxter, Blaise W. ^{[25
]}

Devlin, Thomas G. ^{[26
]}

Lopes, Demetrius K. ^{[27
]}

Reddy, Vivek K. ^{[21
]}

de Rochemont, Richard du Mesnil ^{[15
]}

Singer, Oliver C. ^{[16
]}

Jahan, Reza ^{[3
]}

机构：

[1] Univ Calif Los Angeles, Dept Neurol, Los Angeles, CA 90095 USA

[2] Univ Calif Los Angeles, David Geffen Sch Med, Comprehens Stroke Ctr, Los Angeles, CA 90095 USA

[3] Univ Calif Los Angeles, Div Intervent Neuroradiol, Los Angeles, CA 90095 USA

[4] Stanford Univ, Sch Med, Dept Neurol & Neurol Sci, Stanford, CA 94305 USA

[5] Univ Calgary, Dept Radiol, Calgary, AB, Canada

[6] Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada

[7] Univ Toronto, Div Neuroradiol, Toronto, ON, Canada

[8] Univ Toronto, Div Neurosurg, Dept Med Imaging, Toronto, ON, Canada

[9] Univ Toronto, Toronto Western Hosp, Univ Hlth Network, Dept Surg, Toronto, ON M5T 2S8, Canada

[10] Hop Gui de Chauliac, Dept Neuroradiol, Montpellier, France

[11] Univ Hosp Toulouse, Dept Diagnost & Therapeut Neuroradiol, Toulouse, France

[12] Univ Duisburg Essen, Univ Hosp, Dept Neurol, Essen, Germany

[13] Heidelberg Univ, Dept Neurol, Heidelberg, Germany

[14] Univ Kiel, Dept Radiol & Neuroradiol, Kiel, Germany

[15] Klinikum Goethe Univ, Inst Neuroradiol, Frankfurt, Germany

[16] Klinikum Goethe Univ, Dept Neurol, Frankfurt, Germany

[17] SUNY Buffalo, Dept Neurosurg, Buffalo, NY 14260 USA

[18] SUNY Buffalo, Toshiba Stroke & Vasc Res Ctr, Buffalo, NY 14260 USA

[19] St Lukes Mid Amer Heart Inst, Kansas City, MO 64108 USA

[20] Univ Missouri, Sch Med, Kansas City, MO 64108 USA

[21] Univ Pittsburgh, Dept Neurol, Med Ctr, Pittsburgh, PA 15260 USA

[22] Univ Bern, Inselspital, Dept Neurol, CH-3010 Bern, Switzerland

[23] Emory Univ, Sch Med, Dept Neurol, Marcus Stroke & Neurosci Ctr,Grady Mem Hosp, Atlanta, GA 30322 USA

[24] Univ Miami, Miller Sch Med, Dept Neurol & Neurosurg, Jackson Mem Hosp, Miami, FL 33136 USA

[25] Univ Tennessee, Dept Radiol, Erlanger Hosp, Chattanooga, TN USA

[26] Univ Tennessee, Div Neurol, Erlanger Hosp, Chattanooga, TN USA

[27] Rush Univ, Dept Neurosurg, Med Ctr, Chicago, IL 60612 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2015年 / 372卷 / 24期

关键词：

ACUTE ISCHEMIC-STROKE; TISSUE-PLASMINOGEN ACTIVATOR; ENDOVASCULAR TREATMENT; RETROSPECTIVE MULTICENTER; ARTERIAL-OCCLUSION; IMAGING SELECTION; SOLITAIRE FR; TRIAL; THERAPY; REVASCULARIZATION;

D O I：

10.1056/NEJMoa1415061

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome. METHODS We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group). Patients had confirmed occlusions in the proximal anterior intracranial circulation and an absence of large ischemic-core lesions. The primary outcome was the severity of global disability at 90 days, as assessed by means of the modified Rankin scale (with scores ranging from 0 [no symptoms] to 6 [death]). RESULTS The study was stopped early because of efficacy. At 39 centers, 196 patients underwent randomization (98 patients in each group). In the intervention group, the median time from qualifying imaging to groin puncture was 57 minutes, and the rate of substantial reperfusion at the end of the procedure was 88%. Thrombectomy with the stent retriever plus intravenous t-PA reduced disability at 90 days over the entire range of scores on the modified Rankin scale (P< 0.001). The rate of functional independence (modified Rankin scale score, 0 to 2) was higher in the intervention group than in the control group (60% vs. 35%, P< 0.001). There were no significant between-group differences in 90-day mortality (9% vs. 12%, P = 0.50) or symptomatic intracranial hemorrhage (0% vs. 3%, P = 0.12). CONCLUSIONS In patients receiving intravenous t-PA for acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, thrombectomy with a stent retriever within 6 hours after onset improved functional outcomes at 90 days.

引用

页码：2285 / 2295

页数：11

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