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http://hdl.handle.net/2445/125710
Title: | Thrombectomy within 8 hours after symptom onset in ischemic stroke |
Author: | Jovin, Tudor G. Chamorro Sánchez, Ángel Cobo, Erik Miquel, Maria Angeles de Molina, Carlos A. Rovira, Alex San Román, Luis Serena, Joaquín Abilleira, Sonia Ribó Panosa, Marc Millán, Mònica Urra, Xabier Cardona-Portela, Pere López Cancio, Elena Tomasello, Alejandro Castaño, Carlos Blasco, Jordi Aja, Lucía Dorado, Laura Quesada, Helena Rubiera, Marta Hernández Pérez, María Goyal, Mayank Demchuk, Andrew M. Kummer, Rüdiger von Gallofré, Miquel Dávalos, Antoni REVASCAT Trial Investigators |
Keywords: | Malalties cerebrovasculars Isquèmia cerebral Cerebrovascular disease Cerebral ischemia |
Issue Date: | 11-Jun-2015 |
Publisher: | Massachusetts Medical Society |
Abstract: | BACKGROUND: We aimed to assess the safety and efficacy of thrombectomy for the treatment of stroke in a trial embedded within a population-based stroke reperfusion registry. METHODS: During a 2-year period at four centers in Catalonia, Spain, we randomly assigned 206 patients who could be treated within 8 hours after the onset of symptoms of acute ischemic stroke to receive either medical therapy (including intravenous alteplase when eligible) and endovascular therapy with the Solitaire stent retriever (thrombectomy group) or medical therapy alone (control group). All patients had confirmed proximal anterior circulation occlusion and the absence of a large infarct on neuroimaging. In all study patients, the use of alteplase either did not achieve revascularization or was contraindicated. The primary outcome was the severity of global disability at 90 days, as measured on the modified Rankin scale (ranging from 0 [no symptoms] to 6 [death]). Although the maximum planned sample size was 690, enrollment was halted early because of loss of equipoise after positive results for thrombectomy were reported from other similar trials. RESULTS Thrombectomy reduced the severity of disability over the range of the modified Rankin scale (adjusted odds ratio for improvement of 1 point, 1.7; 95% confidence interval [CI], 1.05 to 2.8) and led to higher rates of functional independence (a score of 0 to 2) at 90 days (43.7% vs. 28.2%; adjusted odds ratio, 2.1; 95% CI, 1.1 to 4.0). At 90 days, the rates of symptomatic intracranial hemorrhage were 1.9% in both the thrombectomy group and the control group (P = 1.00), and rates of death were 18.4% and 15.5%, respectively (P = 0.60). Registry data indicated that only eight patients who met the eligibility criteria were treated outside the trial at participating hospitals. CONCLUSIONS: Among patients with anterior circulation stroke who could be treated within 8 hours after symptom onset, stent retriever thrombectomy reduced the severity of post-stroke disability and increased the rate of functional independence. |
Note: | Reproducció del document publicat a: https://doi.org/10.1056/NEJMoa1503780 |
It is part of: | New England Journal of Medicine, 2015, vol. 372, num. 24, p. 2296-2306 |
URI: | http://hdl.handle.net/2445/125710 |
Related resource: | https://doi.org/10.1056/NEJMoa1503780 |
Appears in Collections: | Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
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