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Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size.
Costalat, Vincent; Jovin, Tudor G; Albucher, J F; Cognard, Christophe; Henon, Hilde; Nouri, Nasreddine; Gory, Benjamin; Richard, Sebastien; Marnat, Gaultier; Sibon, Igor; Di Maria, Federico; Annan, Mariam; Boulouis, Grégoire; Cardona, Pere; Obadia, Michael; Piotin, Michel; Bourcier, Romain; Guillon, Benoit; Godard, Sophie; Pasco-Papon, Anne; Eker, Omer F; Cho, Tae-Hee; Turc, Guillaume; Naggara, Olivier; Velasco, Stéphane; Lamy, Matthias; Clarençon, Frédéric; Alamowitch, Sonia; Renu, Arturo; Suissa, Laurent; Brunel, Hervé; Gentric, Jean-Christophe; Timsit, Serge; Lamy, Chantal; Chivot, Cyril; Macian-Montoro, Francisco; Mounayer, Charbel; Ozkul-Wermester, Ozlem; Papagiannaki, Chrysanthi; Wolff, Valérie; Pop, Raoul; Ferrier, Anna; Chabert, Emmanuel; Ricolfi, Frédéric; Béjot, Yannick; Lopez-Cancio, Elena; Vega, Pedro; Spelle, Laurent; Denier, Christian; Millán, Mònica.
Afiliación
  • Costalat V; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Jovin TG; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Albucher JF; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Cognard C; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Henon H; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Nouri N; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Gory B; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Richard S; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Marnat G; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Sibon I; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Di Maria F; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Annan M; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Boulouis G; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Cardona P; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Obadia M; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Piotin M; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Bourcier R; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Guillon B; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Godard S; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Pasco-Papon A; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Eker OF; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Cho TH; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Turc G; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Naggara O; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Velasco S; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Lamy M; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Clarençon F; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Alamowitch S; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Renu A; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Suissa L; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Brunel H; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Gentric JC; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Timsit S; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Lamy C; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Chivot C; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Macian-Montoro F; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Mounayer C; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Ozkul-Wermester O; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Papagiannaki C; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Wolff V; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Pop R; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Ferrier A; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Chabert E; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Ricolfi F; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Béjot Y; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Lopez-Cancio E; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Vega P; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Spelle L; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Denier C; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
  • Millán M; From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Ne
N Engl J Med ; 390(18): 1677-1689, 2024 May 09.
Article en En | MEDLINE | ID: mdl-38718358
ABSTRACT

BACKGROUND:

The use of thrombectomy in patients with acute stroke and a large infarct of unrestricted size has not been well studied.

METHODS:

We assigned, in a 11 ratio, patients with proximal cerebral vessel occlusion in the anterior circulation and a large infarct (as defined by an Alberta Stroke Program Early Computed Tomographic Score of ≤5; values range from 0 to 10) detected on magnetic resonance imaging or computed tomography within 6.5 hours after symptom onset to undergo endovascular thrombectomy and receive medical care (thrombectomy group) or to receive medical care alone (control group). The primary outcome was the score on the modified Rankin scale at 90 days (scores range from 0 to 6, with higher scores indicating greater disability). The primary safety outcome was death from any cause at 90 days, and an ancillary safety outcome was symptomatic intracerebral hemorrhage.

RESULTS:

A total of 333 patients were assigned to either the thrombectomy group (166 patients) or the control group (167 patients); 9 were excluded from the analysis because of consent withdrawal or legal reasons. The trial was stopped early because results of similar trials favored thrombectomy. Approximately 35% of the patients received thrombolysis therapy. The median modified Rankin scale score at 90 days was 4 in the thrombectomy group and 6 in the control group (generalized odds ratio, 1.63; 95% confidence interval [CI], 1.29 to 2.06; P<0.001). Death from any cause at 90 days occurred in 36.1% of the patients in the thrombectomy group and in 55.5% of those in the control group (adjusted relative risk, 0.65; 95% CI, 0.50 to 0.84), and the percentage of patients with symptomatic intracerebral hemorrhage was 9.6% and 5.7%, respectively (adjusted relative risk, 1.73; 95% CI, 0.78 to 4.68). Eleven procedure-related complications occurred in the thrombectomy group.

CONCLUSIONS:

In patients with acute stroke and a large infarct of unrestricted size, thrombectomy plus medical care resulted in better functional outcomes and lower mortality than medical care alone but led to a higher incidence of symptomatic intracerebral hemorrhage. (Funded by Montpellier University Hospital; LASTE ClinicalTrials.gov number, NCT03811769.).
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Terapia Trombolítica / Trombectomía / Accidente Cerebrovascular / Infarto de la Arteria Cerebral Anterior Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: N Engl J Med Año: 2024 Tipo del documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Terapia Trombolítica / Trombectomía / Accidente Cerebrovascular / Infarto de la Arteria Cerebral Anterior Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: N Engl J Med Año: 2024 Tipo del documento: Article