Data di Pubblicazione:
2013
Citazione:
Endovascular treatment for acute ischemic stroke / A. Ciccone, L. Valvassori, M. Nichelatti, A. Sgoifo, M. Ponzio, R. Sterzi, E. Boccardi, L. Pantoni. - In: NEW ENGLAND JOURNAL OF MEDICINE. - ISSN 0028-4793. - 368:10(2013 Mar), pp. 904-913. [10.1056/NEJMoa1213701]
Abstract:
BACKGROUND: In patients with ischemic stroke, endovascular treatment results in a higher rate of recanalization of the affected cerebral artery than systemic intravenous thrombolytic therapy. However, comparison of the clinical efficacy of the two approaches is needed. METHODS: We randomly assigned 362 patients with acute ischemic stroke, within 4.5 hours after onset, to endovascular therapy (intraarterial thrombolysis with recombinant tissue plasminogen activator [t-PA], mechanical clot disruption or retrieval, or a combination of these approaches) or intravenous t-PA. Treatments were to be given as soon as possible after randomization. The primary outcome was survival free of disability (defined as a modified Rankin score of 0 or 1 on a scale of 0 to 6, with 0 indicating no symptoms, 1 no clinically significant disability despite symptoms, and 6 death) at 3 months. RESULTS: A total of 181 patients were assigned to receive endovascular therapy, and 181 intravenous t-PA. The median time from stroke onset to the start of treatment was 3.75 hours for endovascular therapy and 2.75 hours for intravenous t-PA (P<0.001). At 3 months, 55 patients in the endovascular-therapy group (30.4%) and 63 in the intravenous t-PA group (34.8%) were alive without disability (odds ratio adjusted for age, sex, stroke severity, and atrial fibrillation status at baseline, 0.71; 95% confidence interval, 0.44 to 1.14; P = 0.16). Fatal or nonfatal symptomatic intracranial hemorrhage within 7 days occurred in 6% of the patients in each group, and there were no significant differences between groups in the rates of other serious adverse events or the case fatality rate. CONCLUSIONS: The results of this trial in patients with acute ischemic stroke indicate that endovascular therapy is not superior to standard treatment with intravenous t-PA. (Funded by the Italian Medicines Agency, ClinicalTrials.gov number, NCT00640367.).
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Acute Disease; Adult; Aged; Brain Ischemia; Cerebral Angiography; Cerebral Hemorrhage; Combined Modality Therapy; Endovascular Procedures; Female; Fibrinolytic Agents; Humans; Infusions, Intravenous; Male; Middle Aged; Single-Blind Method; Stroke; Tissue Plasminogen Activator; Treatment Outcome; Thrombectomy; Medicine (all)
Elenco autori:
C. A., V. L., N. M., S. A., P. M., S. R., B. E., L. Pantoni
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