Endovascular thrombectomy plus medical care versus medical care alone for large ischaemic stroke: 1-year outcomes of the SELECT2 trial

被引：23

作者：

Sarraj, Amrou ^{[1
,3
]}

Abraham, Michael G. ^{[5
]}

Hassan, Ameer E. ^{[6
]}

Blackburn, Spiros ^{[7
]}

Kasner, Scott E. ^{[10
]}

Ortega-Gutierrez, Santiago ^{[11
]}

Hussain, Muhammad Shazam ^{[12
]}

Chen, Michael ^{[13
]}

Johns, Hannah ^{[14
]}

Churilov, Leonid ^{[14
]}

Pujara, Deep K. ^{[1
,3
]}

Shaker, Faris ^{[7
]}

Maali, Laith ^{[5
]}

Portela, Pere Cardona ^{[15
]}

Herial, Nabeel A. ^{[16
]}

Gibson, Daniel ^{[17
]}

Kozak, Osman ^{[18
]}

Arenillas, Juan F. ^{[19
]}

Yan, Bernard ^{[14
,20
]}

de la Ossa, Natalia Perez ^{[21
]}

Sundararajan, Sophia ^{[1
,3
]}

Hu, Yin C. ^{[2
,4
]}

Cordato, Dennis J. ^{[22
,27
]}

Manning, Nathan W. ^{[23
]}

Hanel, Ricardo A. ^{[24
]}

Aghaebrahim, Amin N. ^{[24
]}

Budzik, Ronald F. ^{[25
]}

Hicks, William J. ^{[26
]}

Blasco, Jordi ^{[27
]}

Wu, Teddy Y. ^{[28
]}

Tsai, Jenny P. ^{[12
]}

Schaafsma, Joanna D. ^{[29
]}

Gandhi, Chirag D. ^{[30
]}

Al-Mufti, Fawaz ^{[30
]}

Sangha, Navdeep ^{[31
]}

Warach, Steven ^{[32
]}

Kleinig, Timothy J. ^{[33
]}

Yogendrakumar, Vignan ^{[20
]}

Ng, Felix ^{[20
]}

Samaniego, Edgar A. ^{[11
]}

Abdulrazzak, Mohammad A. ^{[12
]}

Parsons, Mark W. ^{[22
]}

Rahbar, Mohammad H. ^{[8
]}

Nguyen, Thanh N. ^{[34
]}

Fifi, Johanna T. ^{[35
]}

Pereira, Vitor Mendes ^{[36
]}

Lansberg, Maarten G. ^{[37
]}

Albers, Greg W. ^{[37
]}

Furlan, Anthony J. ^{[1
,3
]}

Jabbour, Pascal ^{[16
]}

机构：

[1] Univ Hosp Cleveland Med Ctr, Dept Neurol, Cleveland, OH 44106 USA

[2] Univ Hosp Cleveland Med Ctr, Dept Neurosurg, Cleveland, OH USA

[3] Case Western Reserve Univ, Dept Neurol, Cleveland, OH USA

[4] Case Western Reserve Univ, Dept Neurosurg, Cleveland, OH USA

[5] Univ Kansas, Med Ctr, Dept Neurol, Kansas City, KS USA

[6] Valley Baptist Med Ctr, Dept Neurosci, Harlingen, TX USA

[7] McGovern Med Sch UTHealth, Dept Neurosurg, Houston, TX USA

[8] UTHlth, Dept Internal Med, McGovern Med Sch, Houston, TX USA

[9] UTHlth, Dept Intervent & Diagnost Imaging, McGovern Med Sch, Houston, TX USA

[10] Univ Penn, Dept Neurol, Philadelphia, PA USA

[11] Univ Iowa Hosp & Clin, Dept Neurosurg & Radiol, Iowa City, IA USA

[12] Cleveland Clin, Cerebrovasc Ctr, Cleveland, OH USA

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

[14] Univ Melbourne, Dept Med & Neurol, Parkville, Vic, Australia

[15] Hosp Univ Bellvitge, Dept Neurol, Bellvitge, Spain

[16] Thomas Jefferson Univ Hosp, Dept Neurosurg, Philadelphia, PA USA

[17] Ascension Wisconsin, Dept Neurosurg, Indianapolis, IN USA

[18] Abington Jefferson Hlth, Dept Neurosurg, Abington, PA USA

[19] Univ Valladolid, Hosp Clin Univ Valladolid, Dept Internal Med, Valladolid, Spain

[20] Royal Melbourne Hosp, Melbourne Brain Ctr, Dept Internal Med & Neurol, Parkville, Vic, Australia

[21] Hosp Univ Germans Trias i Pujol, Dept Neurol, Barcelona, Spain

[22] Liverpool Hosp, Dept Neurol, Liverpool, NSW, Australia

[23] Ingham Inst, Dept Neurosurg, Liverpool, NSW, Australia

[24] Baptist Med Ctr Jacksonville, Dept Neurosurg, Jacksonville, FL USA

[25] OhioHlth Riverside Methodist Hosp, Dept Neurointervent Radiol, Columbus, OH USA

[26] OhioHlth Riverside Methodist Hosp, Dept Neurol, Columbus, OH USA

[27] Hosp Clin Barcelona, Dept Intervent Radiol, Barcelona, Spain

[28] Christchurch Hosp, Dept Neurol, Christchurch, New Zealand

[29] Toronto Western Hosp, Dept Internal Med, Toronto, ON, Canada

[30] NY Med Coll, Westchester Med Ctr, Dept Neurosurg, Valhalla, NY USA

[31] Kaiser Permanente Southern Calif, Dept Neurol, Los Angeles, CA USA

[32] Univ Texas Austin Ascension Texas, Dell Med Sch, Dept Neurol, Austin, TX USA

[33] Royal Adelaide Hosp, Dept Neurol, Adelaide, SA, Australia

[34] Boston Med Ctr, Dept Neurol, Boston, MA USA

[35] Icahn Sch Med Mt Sinai, Dept Neurol, New York, NY USA

[36] St Michaels Hosp, Dept Neurol, Toronto, ON, Canada

[37] Stanford Univ, Dept Neurol, Stanford, CA USA

[38] Univ Pittsburgh, Med Ctr, Dept Neurol, Pittsburgh, PA USA

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

[40] Mem Hermann Hosp, Mobile Stroke Unit, Houston, TX USA

[41] Hosp Valle De Hebron, Dept Neurol, Barcelona, Spain

[42] Florey Inst Neurosci & Mental Hlth, Dept Med & Neurol, Parkville, Vic, Australia

来源：

LANCET | 2024年 / 403卷 / 10428期

关键词：

HUMAN BRAIN;

D O I：

10.1016/S0140-6736(24)00050-3

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Multiple randomised trials have shown efficacy and safety of endovascular thrombectomy in patients with large ischaemic stroke. The aim of this study was to evaluate long-term (ie, at 1 year) evidence of benefit of thrombectomy for these patients. Methods SELECT2 was a phase 3, open-label, international, randomised controlled trial with blinded endpoint assessment, conducted at 31 hospitals in the USA, Canada, Spain, Switzerland, Australia, and New Zealand. Patients aged 18-85 years with ischaemic stroke due to proximal occlusion of the internal carotid artery or of the first segment of the middle cerebral artery, showing large ischaemic core on non-contrast CT (Alberta Stroke Program Early Computed Tomographic Score of 3-5 [range 0-10, with lower values indicating larger infarctions]) or measuring 50 mL or more on CT perfusion and MRI, were randomly assigned, within 24 h of ischaemic stroke onset, to thrombectomy plus medical care or to medical care alone. The primary outcome for this analysis was the ordinal modified Rankin Scale (range 0-6, with higher scores indicating greater disability) at 1-year follow-up in an intention-to-treat population. The trial is registered at ClinicalTrials.gov (NCT03876457) and is completed. Findings The trial was terminated early for efficacy at the 90-day follow-up after 352 patients had been randomly assigned (178 to thrombectomy and 174 to medical care only) between Oct 11, 2019, and Sept 9, 2022. Thrombectomy significantly improved the 1-year modified Rankin Scale score distribution versus medical care alone (WilcoxonMann-Whitney probability of superiority 0<middle dot>59 [95% CI 0<middle dot>53-0<middle dot>64]; p=0<middle dot>0019; generalised odds ratio 1<middle dot>43 [95% CI 1<middle dot>14-1<middle dot>78]). At the 1-year follow-up, 77 (45%) of 170 patients receiving thrombectomy had died, compared with 83 (52%) of 159 patients receiving medical care only (1-year mortality relative risk 0<middle dot>89 [95% CI 0<middle dot>71-1<middle dot>11]). Interpretation In patients with ischaemic stroke due to a proximal occlusion and large core, thrombectomy plus medical care provided a significant functional outcome benefit compared with medical care alone at 1-year follow-up. Funding Stryker Neurovascular. Copyright (c) 2024 Elsevier Ltd. All rights reserved.

引用

页码：731 / 740

页数：10

共 32 条

[1] Endovascular thrombectomy plus medical care versus medical care alone for large ischaemic stroke: 1 year outcomes of the SELECT2 trial
Coratza, Giovanni
Musmeci, Marco
Pacenti, Nikla
Pacinella, Gaetano
INTERNAL AND EMERGENCY MEDICINE, 2025, 20 (01) : 291 - 293
[2] Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: A randomized care trial
Khoury, Naim N.
Darsaut, Tim E.
Ghostine, Jimmy
Deschaintre, Yan
Daneault, Nicole
Durocher, Andre
Lanthier, Sylvain
Pope, Alexandre Y.
Odier, Celine
Lebrun, Louise-Helene
Guilbert, Francois
Gentric, Jean-Christophe
Batista, Andre
Weill, Alain
Roy, Daniel
Bracard, Serge
Raymond, Jean
JOURNAL OF NEURORADIOLOGY, 2017, 44 (03) : 198 - 202
[3] Endovascular Thrombectomy and Medical Therapy Versus Medical Therapy Alone in Acute Stroke (EASI): a Randomized Care Trial.
Khoury, Naim N.
Darsaut, Tim E.
Ghostine, Jimmy
Deschaintre, Yan
Daneault, Nicole
Durocher, Andre
Lanthier, Sylvain
Poppe, Alexandre
Odier, Celine
Lebrun, Louise-Helene
Guilbert, Francois
Gentric, Jean-Christophe
Batista, Andre
Weill, Alain
Roy, Daniel
Bracard, Serge
STROKE, 2016, 47
[4] Relationship of Collateral Status With Clinical Outcomes in Endovascular Thrombectomy for Large Core Stroke: A SELECT2 Subanalysis
Sarraj, Amrou
Hassan, Ameer E.
Abraham, Michael G.
Chen, Michael
Hussain, Muhammad S.
Kasner, Scott E.
Ortega-Gutierrez, Santiago
Churilov, Leonid
Pujara, Deep
Shaker, Faris
Johns, Hannah
Al-Shaibi, Faisal
Duncan, Kelsey R.
Pereira, Vitor Mendes
Sitton, Clark W.
Lansberg, Maarten G.
Albers, Gregory W.
Davis, Stephen M.
Wechsler, Lawrence R.
Grotta, James C.
Hill, Michael D.
Ribo, Marc
Campbell, Bruce
STROKE, 2024, 55
[5] Anticoagulation Use and Endovascular Thrombectomy in Patients with Large Core Stroke: A Secondary Analysis of the SELECT2 Trial
Pujara, Deep K.
Hussain, M. Shazam
Abraham, Michael G.
Ortega-Gutierrez, Santiago
Chen, Michael
Kasner, Scott E.
Churilov, Leonid
Sitton, Clark W.
Blackburn, Spiros
Sundararajan, Sophia
Hu, Yin C.
Herial, Nabeel A.
Budzik, Ronald F.
Hicks, William J.
Arenillas, Juan F.
Tsai, Jenny P.
Kozak, Osman
Cordato, Dennis J.
Manning, Nathan W.
Hanel, Ricardo A.
Aghaebrahim, Amin N.
Wu, Teddy Y.
Portela, Pere Cardona
de la Ossa, Natalia Perez
Schaafsma, Joanna D.
Blasco, Jordi
Sangha, Navdeep
Warach, Steven
Gandhi, Chirag D.
Al-Mufti, Fawaz
Kleinig, Timothy J.
Al-Shaibi, Faisal
Duncan, Kelsey R.
Shaker, Faris
Johns, Hannah
Xiong, Wei
Degeorgia, Michael
Opaskar, Amanda
Sunshine, Jeffery
Ray, Abhishek
Jabbour, Pascal
Bambakidis, Nicholas
Sila, Cathy
Nguyen, Thanh N.
Grotta, James C.
Hassan, Ameer E.
Ribo, Marc
Hill, Michael D.
Campbell, Bruce C.
Sarraj, Amrou
ANNALS OF NEUROLOGY, 2024, 96 (05) : 887 - 894
[6] Sex-Based Differences in Endovascular Thrombectomy Outcomes for Large Ischemic Stroke: A SELECT2 Subanalysis
Tsai, Jenny P.
Nguyen, Thanh N.
Pujara, Deep K.
Fifi, Johanna T.
Sundararajan, Sophia
Schaafsma, Joanna D.
Perez de la Ossa, Natalia
Abraham, Michael G.
Chen, Michael
Hussain, Muhammad S.
Ortega-Gutierrez, Santiago
Johns, Hannah T.
Duncan, Kelsey R.
Churilov, Leonid
Lechtenberg, Colleen G.
Slavin, Sabreena J.
Opaskar, Amanda
de Lera, Mercedes
Lara-Rodriguez, Blanca
Quesada, Helena
Fournier, Lauren E.
Defta, Dana M.
Shaker, Faris
Sitton, Clark W.
Sharrief, Anjail Z.
Grotta, James C.
Hill, Michael D.
Ribo, Marc
Hassan, Ameer E.
Campbell, Bruce C. V.
Sila, Cathy
Tjoumakaris, Stavropoula I.
Sarraj, Amrou
STROKE, 2025, 56 (02) : 294 - 304
[7] Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: A randomized care trial (vol 44, pg 198, 2017)
Khoury, Naim N.
Darsaut, Tim E.
Ghostine, Jimmy
Deschaintre, Yan
Daneault, Nicole
Durocher, Andre
Lanthier, Sylvain
Poppe, Alexandre Y.
Odier, Celine
Lebrun, Louise-Helene
Guilbert, Francois
Gentric, Jean-Christophe
Batista, Andre
Weill, Alain
Roy, Daniel
Bracard, Serge
Raymond, Jean
JOURNAL OF NEURORADIOLOGY, 2017, 44 (05) : 351 - 351
[8] Sex-Based Differences in Endovascular Thrombectomy Outcomes for Large Ischemic Stroke: A SELECT2 Subanalysis
Tsai, Jenny P.
Thanh Nguyen
Johanna, Fifi T.
Sundararajan, Sophia
Schaafsma, Joanna D.
de la Ossa, Natalia Perez
Abraham, Michael G.
STROKE, 2024, 55
[9] Outcome Differences Between Endovascular Thrombectomy and Medical Management Based on Underlying Stroke Etiology: A Secondary Analysis of SELECT2 Trial
Shaker, Faris
Pujara, Deep
Abraham, Michael G.
Chen, Michael
Kasner, Scott E.
Ortega-Gutierrez, Santiago
Hussain, Muhammad S.
STROKE, 2024, 55
[10] Anticoagulation Use and Endovascular Thrombectomy in Patients With Large Core Stroke - A Secondary Analysis of SELECT2 Trial
Pujara, Deep
Shaker, Faris
Abraham, Michael G.
Chen, Michael
Kasner, Scott
Ortega-Gutierrez, Santiago
Hussain, M. Shazam
Sarraj, Amrou
STROKE, 2024, 55

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