Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial”
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFRN |
DOI: | 10.1016/j.neurad.2017.01.126 |
Texto Completo: | https://repositorio.ufrn.br/handle/123456789/52461 |
Resumo: | 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. |
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Khoury, Naim N.Darsaut, Tim E.Ghostine, JimmyDeschaintre, YanDaneault, NicoleDurocher, AndréLanthier, SylvainPoppe, Alexandre Y.Odier, CélineLebrun, Louise-HélèneGuilbert, FrançoisGentric, Jean-ChristopheBatista, André LimaWeill, AlainRoy, DanielBracard, SergeRaymond, Jean2023-05-17T16:18:24Z2023-05-17T16:18:24Z2017-09KHOURY, Naim N.; DARSAUT, Tim E.; GHOSTINE, Jimmy; DESCHAINTRE, Yan; DANEAULT, Nicole; DUROCHER, André; LANTHIER, Sylvain; POPPE, Alexandre Y.; ODIER, Céline; LEBRUN, Louise-Hélène. Erratum to “Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial⠽ Journal of Neuroradiol. 44 (2017) 198⠳202. Journal Of Neuroradiology, [S.L.], v. 44, n. 5, p. 351, set. 2017. Elsevier BV. DOI; http://dx.doi.org/10.1016/j.neurad.2017.05.005https://repositorio.ufrn.br/handle/123456789/5246110.1016/j.neurad.2017.01.126acute strokeendovascular treatmentthrombectomyrandomized clinical trialEndovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial”info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleBackground. – 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.porreponame:Repositório Institucional da UFRNinstname:Universidade Federal do Rio Grande do Norte (UFRN)instacron:UFRNinfo:eu-repo/semantics/openAccessLICENSElicense.txtlicense.txttext/plain; charset=utf-81484https://repositorio.ufrn.br/bitstream/123456789/52461/2/license.txte9597aa2854d128fd968be5edc8a28d9MD52123456789/524612023-05-17 13:19:43.256oai:https://repositorio.ufrn.br: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Repositório de PublicaçõesPUBhttp://repositorio.ufrn.br/oai/opendoar:2023-05-17T16:19:43Repositório Institucional da UFRN - Universidade Federal do Rio Grande do Norte (UFRN)false |
dc.title.pt_BR.fl_str_mv |
Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial” |
title |
Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial” |
spellingShingle |
Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial” Khoury, Naim N. acute stroke endovascular treatment thrombectomy randomized clinical trial |
title_short |
Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial” |
title_full |
Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial” |
title_fullStr |
Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial” |
title_full_unstemmed |
Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial” |
title_sort |
Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial” |
author |
Khoury, Naim N. |
author_facet |
Khoury, Naim N. 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 |
author_role |
author |
author2 |
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 |
author2_role |
author author author author author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Khoury, Naim N. 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 |
dc.subject.por.fl_str_mv |
acute stroke endovascular treatment thrombectomy randomized clinical trial |
topic |
acute stroke endovascular treatment thrombectomy randomized clinical trial |
description |
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. |
publishDate |
2017 |
dc.date.issued.fl_str_mv |
2017-09 |
dc.date.accessioned.fl_str_mv |
2023-05-17T16:18:24Z |
dc.date.available.fl_str_mv |
2023-05-17T16:18:24Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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publishedVersion |
dc.identifier.citation.fl_str_mv |
KHOURY, Naim N.; DARSAUT, Tim E.; GHOSTINE, Jimmy; DESCHAINTRE, Yan; DANEAULT, Nicole; DUROCHER, André; LANTHIER, Sylvain; POPPE, Alexandre Y.; ODIER, Céline; LEBRUN, Louise-Hélène. Erratum to “Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial⠽ Journal of Neuroradiol. 44 (2017) 198⠳202. Journal Of Neuroradiology, [S.L.], v. 44, n. 5, p. 351, set. 2017. Elsevier BV. DOI; http://dx.doi.org/10.1016/j.neurad.2017.05.005 |
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https://repositorio.ufrn.br/handle/123456789/52461 |
dc.identifier.doi.none.fl_str_mv |
10.1016/j.neurad.2017.01.126 |
identifier_str_mv |
KHOURY, Naim N.; DARSAUT, Tim E.; GHOSTINE, Jimmy; DESCHAINTRE, Yan; DANEAULT, Nicole; DUROCHER, André; LANTHIER, Sylvain; POPPE, Alexandre Y.; ODIER, Céline; LEBRUN, Louise-Hélène. Erratum to “Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial⠽ Journal of Neuroradiol. 44 (2017) 198⠳202. Journal Of Neuroradiology, [S.L.], v. 44, n. 5, p. 351, set. 2017. Elsevier BV. DOI; http://dx.doi.org/10.1016/j.neurad.2017.05.005 10.1016/j.neurad.2017.01.126 |
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