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Thrombectomy for Stroke in the Public Health Care System of Brazil.
Martins, Sheila O; Mont'Alverne, Francisco; Rebello, Letícia C; Abud, Daniel G; Silva, Gisele S; Lima, Fabrício O; Parente, Bruno S M; Nakiri, Guilherme S; Faria, Mário B; Frudit, Michel E; de Carvalho, João J F; Waihrich, Eduardo; Fiorot, José A; Cardoso, Fabrício B; Hidalgo, Raquel C T; Zétola, Viviane F; Carvalho, Fernanda M; de Souza, Ana C; Dias, Francisco A; Bandeira, Diego; Miranda Alves, Maramélia; Wagner, Mário B; Carbonera, Leonardo A; Oliveira-Filho, Jamary; Bezerra, Daniel C; Liebeskind, David S; Broderick, Joseph; Molina, Carlos A; Fogolin Passos, José E; Saver, Jeffrey L; Pontes-Neto, Octávio M; Nogueira, Raul G.
Afiliação
  • Martins SO; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Mont'Alverne F; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Rebello LC; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Abud DG; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Silva GS; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Lima FO; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Parente BSM; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Nakiri GS; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Faria MB; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Frudit ME; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • de Carvalho JJF; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Waihrich E; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Fiorot JA; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Cardoso FB; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Hidalgo RCT; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Zétola VF; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Carvalho FM; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • de Souza AC; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Dias FA; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Bandeira D; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Miranda Alves M; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Wagner MB; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Carbonera LA; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Oliveira-Filho J; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Bezerra DC; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Liebeskind DS; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Broderick J; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Molina CA; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Fogolin Passos JE; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Saver JL; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Pontes-Neto OM; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
  • Nogueira RG; From the Departments of Neurology (S.O.M., A.C.S., L.A.C.), Interventional Neuroradiology (M.B.F.), and Social Medicine (M.B.W.), Federal University of Rio Grande do Sul, and Hospital de Clínicas de Porto Alegre (S.O.M., A.C.S., L.A.C., M.B.W.), Porto Alegre, the Departments of Interventional Neuror
N Engl J Med ; 382(24): 2316-2326, 2020 06 11.
Article em En | MEDLINE | ID: mdl-32521133
ABSTRACT

BACKGROUND:

Randomized trials involving patients with stroke have established that outcomes are improved with the use of thrombectomy for large-vessel occlusion. These trials were performed in high-resource countries and have had limited effects on medical practice in low- and middle-income countries.

METHODS:

We studied the safety and efficacy of thrombectomy in the public health system of Brazil. In 12 public hospitals, patients with a proximal intracranial occlusion in the anterior circulation that could be treated within 8 hours after the onset of stroke symptoms were randomly assigned in a 11 ratio to receive standard care plus mechanical thrombectomy (thrombectomy group) or standard care alone (control group). The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days.

RESULTS:

A total of 300 patients were enrolled, including 79 who had undergone thrombectomy during an open-label roll-in period. Approximately 70% in the two groups received intravenous alteplase. The trial was stopped early because of efficacy when 221 of a planned 690 patients had undergone randomization (111 to the thrombectomy group and 110 to the control group). The common odds ratio for a better distribution of scores on the modified Rankin scale at 90 days was 2.28 (95% confidence interval [CI], 1.41 to 3.69; P = 0.001), favoring thrombectomy. The percentage of patients with a score on the modified Rankin scale of 0 to 2, signifying an absence of or minor neurologic deficit, was 35.1% in the thrombectomy group and 20.0% in the control group (difference, 15.1 percentage points; 95% CI, 2.6 to 27.6). Asymptomatic intracranial hemorrhage occurred in 51.4% of the patients in the thrombectomy group and 24.5% of those in the control group; symptomatic intracranial hemorrhage occurred in 4.5% of the patients in each group.

CONCLUSIONS:

In this randomized trial conducted in the public health care system of Brazil, endovascular treatment within 8 hours after the onset of stroke symptoms in conjunction with standard care resulted in better functional outcomes at 90 days than standard care alone. (Funded by the Brazilian Ministry of Health; RESILIENT ClinicalTrials.gov number, NCT02216643.).
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Trombectomia / Acidente Vascular Cerebral Tipo de estudo: Clinical_trials / Etiology_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Brasil Idioma: En Ano de publicação: 2020 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Trombectomia / Acidente Vascular Cerebral Tipo de estudo: Clinical_trials / Etiology_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Brasil Idioma: En Ano de publicação: 2020 Tipo de documento: Article