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Article Dans Une Revue New England Journal of Medicine Année : 2018

Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct

Raul G. Nogueira
  • Fonction : Auteur
Ashutosh P. Jadhav
  • Fonction : Auteur
Diogo C. Haussen
  • Fonction : Auteur
Ronald F. Budzik
  • Fonction : Auteur
Parita Bhuva
  • Fonction : Auteur
Dileep R. Yavagal
  • Fonction : Auteur
Marc Ribo
Ricardo A. Hanel
  • Fonction : Auteur
Cathy A. Sila
  • Fonction : Auteur
Ameer E. Hassan
  • Fonction : Auteur
Monica Millan
  • Fonction : Auteur
Elad I. Levy
  • Fonction : Auteur
Peter Mitchell
  • Fonction : Auteur
Michael Chen
  • Fonction : Auteur
Joey D. English
  • Fonction : Auteur
Qaisar A. Shah
  • Fonction : Auteur
Frank L. Silver
  • Fonction : Auteur
Vitor M. Pereira
  • Fonction : Auteur
Brijesh P. Mehta
  • Fonction : Auteur
Blaise W. Baxter
  • Fonction : Auteur
Michael G. Abraham
  • Fonction : Auteur
Pedro Cardona
  • Fonction : Auteur
Erol Veznedaroglu
  • Fonction : Auteur
Frank R. Hellinger
  • Fonction : Auteur
Lei Feng
  • Fonction : Auteur
Jawad F. Kirmani
  • Fonction : Auteur
Demetrius K. Lopes
  • Fonction : Auteur
Brian T. Jankowitz
  • Fonction : Auteur
Michael R. Frankel
  • Fonction : Auteur
Nirav A. Vora
  • Fonction : Auteur
Albert J. Yoo
  • Fonction : Auteur
Amer M. Malik
  • Fonction : Auteur
Anthony J. Furlan
  • Fonction : Auteur
Marta Rubiera
  • Fonction : Auteur
Amin Aghaebrahim
  • Fonction : Auteur
Jean-Marc Olivot
  • Fonction : Auteur
Wondwossen G. Tekle
  • Fonction : Auteur
Ryan Shields
  • Fonction : Auteur
Todd Graves
  • Fonction : Auteur
Roger J. Lewis
  • Fonction : Auteur
Wade S. Smith
  • Fonction : Auteur
David S. Liebeskind
  • Fonction : Auteur
Jeffrey L. Saver
  • Fonction : Auteur
Tudor G. Jovin
  • Fonction : Auteur

Résumé

BACKGROUND: The effect of endovascular thrombectomy that is performed more than 6 hours after the onset of ischemic stroke is uncertain. Patients with a clinical deficit that is disproportionately severe relative to the infarct volume may benefit from late thrombectomy. METHODS: We enrolled patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who had last been known to be well 6 to 24 hours earlier and who had a mismatch between the severity of the clinical deficit and the infarct volume, with mismatch criteria defined according to age (<80 years or ≥80 years). Patients were randomly assigned to thrombectomy plus standard care (the thrombectomy group) or to standard care alone (the control group). The coprimary end points were the mean score for disability on the utility-weighted modified Rankin scale (which ranges from 0 [death] to 10 [no symptoms or disability]) and the rate of functional independence (a score of 0, 1, or 2 on the modified Rankin scale, which ranges from 0 to 6, with higher scores indicating more severe disability) at 90 days. RESULTS: A total of 206 patients were enrolled; 107 were assigned to the thrombectomy group and 99 to the control group. At 31 months, enrollment in the trial was stopped because of the results of a prespecified interim analysis. The mean score on the utility-weighted modified Rankin scale at 90 days was 5.5 in the thrombectomy group as compared with 3.4 in the control group (adjusted difference [Bayesian analysis], 2.0 points; 95% credible interval, 1.1 to 3.0; posterior probability of superiority, >0.999), and the rate of functional independence at 90 days was 49% in the thrombectomy group as compared with 13% in the control group (adjusted difference, 33 percentage points; 95% credible interval, 24 to 44; posterior probability of superiority, >0.999). The rate of symptomatic intracranial hemorrhage did not differ significantly between the two groups (6% in the thrombectomy group and 3% in the control group, P=0.50), nor did 90-day mortality (19% and 18%, respectively; P=1.00). CONCLUSIONS: Among patients with acute stroke who had last been known to be well 6 to 24 hours earlier and who had a mismatch between clinical deficit and infarct, outcomes for disability at 90 days were better with thrombectomy plus standard care than with standard care alone.

Dates et versions

hal-02387070 , version 1 (29-11-2019)

Identifiants

Citer

Raul G. Nogueira, Ashutosh P. Jadhav, Diogo C. Haussen, Alain Bonafe, Ronald F. Budzik, et al.. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. New England Journal of Medicine, 2018, 378 (1), pp.11--21. ⟨10.1056/NEJMoa1706442⟩. ⟨hal-02387070⟩
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