Endovascular Therapy Is Effective and Safe for Patients With Severe Ischemic Stroke

被引：45

作者：

Broderick, Joseph P. ^{[1
,2
]}

Berkhemer, Olvert A. ^{[20
]}

Palesch, Yuko Y. ^{[4
]}

Dippel, Diederik W. J. ^{[22
,24
]}

Foster, Lydia D. ^{[4
]}

Roos, Yvo B. W. E. M. ^{[21
]}

van der Lugt, Aad ^{[23
]}

Tomsick, Thomas A. ^{[1
,2
]}

Majoie, Charles B. L. M. ^{[20
]}

van Zwam, Wim H. ^{[25
]}

Demchuk, Andrew M. ^{[6
,7
]}

van Oostenbrugge, Robert J. ^{[26
]}

Khatri, Pooja ^{[1
,2
]}

Lingsma, Hester F.

Hill, Michael D. ^{[6
,7
]}

Roozenbeek, Bob ^{[22
,24
]}

Jauch, Edward C. ^{[3
]}

Jovin, Tudor G. ^{[8
]}

Yan, Bernard ^{[9
]}

von Kummer, Ruediger ^{[10
]}

Molina, Carlos A. ^{[11
]}

Goyal, Mayank ^{[6
,7
]}

Schonewille, Wouter J. ^{[12
,13
,14
]}

Mazighi, Mikael ^{[15
,16
]}

Engelter, Stefan T. ^{[17
]}

Anderson, Craig S. ^{[18
]}

Spilker, Judith ^{[1
,2
]}

Carrozzella, Janice ^{[1
,2
]}

Ryckborst, Karla J. ^{[6
,7
]}

Janis, L. Scott ^{[19
]}

Simpson, Kit N. ^{[5
]}

机构：

[1] Univ Cincinnati, Inst Neurosci, Acad Hlth Ctr, Dept Neurol & Rehabil Med, Cincinnati, OH 45267 USA

[2] Univ Cincinnati, Inst Neurosci, Acad Hlth Ctr, Dept Radiol, Cincinnati, OH 45267 USA

[3] Med Univ S Carolina, Div Emergency Med, Charleston, SC USA

[4] Med Univ S Carolina, Dept Publ Hlth Sci, Charleston, SC USA

[5] Med Univ S Carolina, Dept Healthcare Management & Leadership, Charleston, SC USA

[6] Univ Calgary, Hotchkiss Brain Inst, Dept Clin Neurosci, Seaman Family MR Res Ctr,Calgary Stroke Program, Calgary, AB, Canada

[7] Univ Calgary, Hotchkiss Brain Inst, Dept Radiol, Calgary, AB, Canada

[8] Univ Pittsburgh, Med Ctr, Stroke Inst, Pittsburgh, PA 15260 USA

[9] Univ Melbourne, Royal Melbourne Hosp, Melbourne Brain Ctr, Melbourne, Vic 3050, Australia

[10] Dresden Univ, Univ Hosp, Stroke Ctr, Dept Neuroradiol, Dresden, Germany

[11] Hosp Univ Vall dHebron, Dept Neurol, Neurovasc Unit, Barcelona, Spain

[12] Univ Med Ctr Utrecht, Dept Neurol, Utrecht, Netherlands

[13] Rudolph Magnus Inst Neurosci, Utrecht, Netherlands

[14] St Antonius Hosp, Nieuwegein, Netherlands

[15] Lariboisiere Hosp, Dept Neurol, Paris, France

[16] Lariboisiere Hosp, Stroke Ctr, Paris, France

[17] Univ Basel Hosp, Dept Neurol, CH-4031 Basel, Switzerland

[18] Univ Sydney, Royal Prince Alfred Hosp, George Inst Global Hlth, Sydney, NSW 2006, Australia

[19] NINDS, NIH, Bethesda, MD 20892 USA

[20] Univ Amsterdam, Acad Med Ctr, Dept Radiol, NL-1105 AZ Amsterdam, Netherlands

[21] Univ Amsterdam, Acad Med Ctr, Dept Neurol, NL-1105 AZ Amsterdam, Netherlands

[22] Erasmus MC Univ, Med Ctr, Dept Neurol, Rotterdam, Netherlands

[23] Erasmus MC Univ, Med Ctr, Dept Radiol, Rotterdam, Netherlands

[24] Erasmus MC Univ, Med Ctr, Dept Publ Hlth, Rotterdam, Netherlands

[25] Maastricht Univ, Med Ctr, Cardiovasc Res Inst Maastricht CARIM, Dept Radiol, Maastricht, Netherlands

[26] Maastricht Univ, Med Ctr, Cardiovasc Res Inst Maastricht CARIM, Dept Neurol, Maastricht, Netherlands

来源：

STROKE | 2015年 / 46卷 / 12期

基金：

美国国家卫生研究院;

关键词：

clinical trial; endovascular procedures; stroke; tissue-type plasminogen activator; COMPUTED-TOMOGRAPHY SCORE; INTRAVENOUS T-PA; INTERVENTIONAL MANAGEMENT; THROMBECTOMY; TRIAL; TIME; REPERFUSION; OUTCOMES; ONSET;

D O I：

10.1161/STROKEAHA.115.011397

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-We assessed the effect of endovascular treatment in acute ischemic stroke patients with severe neurological deficit (National Institutes of Health Stroke Scale score, >= 20) after a prespecified analysis plan. Methods-The pooled analysis of the Interventional Management of Stroke III (IMS III) and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trials included participants with an National Institutes of Health Stroke Scale score of >= 20 before intravenous tissue-type plasminogen activator (tPA) treatment (IMS III) or randomization (MR CLEAN) who were treated with intravenous tPA <= 3 hours of stroke onset. Our hypothesis was that participants with severe stroke randomized to endovascular therapy after intravenous tPA would have improved 90-day outcome (distribution of modified Rankin Scale scores), when compared with those who received intravenous tPA alone. Results-Among 342 participants in the pooled analysis (194 from IMS III and 148 from MR CLEAN), an ordinal logistic regression model showed that the endovascular group had superior 90-day outcome compared with the intravenous tPA group (adjusted odds ratio, 1.78; 95% confidence interval, 1.20-2.66). In the logistic regression model of the dichotomous outcome (modified Rankin Scale score, 0-2, or functional independence), the endovascular group had superior outcomes (adjusted odds ratio, 1.97; 95% confidence interval, 1.09-3.56). Functional independence (modified Rankin Scale score, <= 2) at 90 days was 25% in the endovascular group when compared with 14% in the intravenous tPA group. Conclusions-Endovascular therapy after intravenous tPA within 3 hours of symptom onset improves functional outcome at 90 days after severe ischemic stroke.

引用

页码：3416 / 3422

页数：7

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