Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial”

• Autor(a) principal: Khoury, Naim N.
• Data de Publicação: 2017
• Outros Autores: Darsaut, Tim E., Ghostine, Jimmy, Deschaintre, Yan, Daneault, Nicole, Durocher, André, Lanthier, Sylvain, Poppe, Alexandre Y., Odier, Céline, Lebrun, Louise-Hélène, Guilbert, François, Gentric, Jean-Christophe, Batista, André Lima, Weill, Alain, Roy, Daniel, Bracard, Serge, Raymond, Jean
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UFRN
• Texto Completo: https://repositorio.ufrn.br/handle/123456789/52461
• topic: acute stroke; endovascular treatment; thrombectomy; randomized clinical trial

Background. – Until recently, the benefits of endovascular treatment in stroke were not proven. Care trials have been designed to simultaneously offer yet-to-be validated interventions and verify treatment outcomes. Our aim was to implement a care trial for patients with acute ischemic stroke. Methods. – The study was offered to all patients considered for endovascular management of acute ischemic stroke in one Canadian hospital. Inclusion criteria were broad: onset of symptoms ≤ 5 h or at any time in the presence of clinical-imaging mismatch and suspected or demonstrated proximal large vessel occlusion. Exclusion criteria were few: established infarction or hemorrhagic transforma tion of the target symptomatic territory and poor 3-month prognosis. The primary outcome was mRS ≤ 2 at 3 months. Patients were randomly allocated to standard care or standard care plus endovascular treatment. ClinicalTrials.gov: Identifier NCT02157532. Results. – Seventy-seven patients were recruited in 19 months (March 2013–October 2014) at a single center. Randomized allocation was interrupted when other trials showed the benefits of endovascular therapy. At 3 months, 20 of 40 patients (50.0%; 95% CI: 35%–65%) in the intervention group had reached the primary outcome, compared to 14 of 37 patients (37.8%; 95% CI: 24%–54%) in the control group (P = 0.36). Eleven patients in the intervention group died within 3 months compared to 9 patients in the standard care group. Conclusion. – A care trial was implemented to offer verifiable care to acute stroke patients. This approach offers a promising means to manage clinical dilemmas and guide uncertain practices.