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

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