University of California [Los Angeles] (UCLA), University of California, Département de Neuroradiologie[Montpellier], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), CHU Toulouse [Toulouse]
المصدر:
New England Journal of Medicine New England Journal of Medicine, Massachusetts Medical Society, 2015, 372 (24), pp.2285-2295. ⟨10.1056/NEJMoa1415061⟩ Saver, J L, Goyal, M, Bonafe, A, Diener, H-C, Levy, E I, Pereira, V M, Albers, G W, Cognard, C, Cohen, D J, Hacke, W, Jansen, O, Jovin, T G, Mattle, H P, Nogueira, R G, Siddiqui, A H, Yavagal, D R, Baxter, B W, Devlin, T G, Lopes, D K, Reddy, V K, du Mesnil de Rochemont, R, Singer, O C, Jahan, R, SWIFT PRIME Investigators (Grethe Andersen, Dorte Damgaard; members), Andersen, G & Damgaard, D W 2015, ' Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke ', The New England Journal of Medicine, vol. 372, no. 24, pp. 2285-2295 . https://doi.org/10.1056/NEJMoa1415061Test Saver, Jeffrey L.; Goyal, Mayank; Bonafe, Alain; Diener, Hans-Christoph; Levy, Elad I.; Pereira, Vitor M.; Albers, Gregory W.; Cognard, Christophe; Cohen, David J.; Hacke, Werner; Jansen, Olav; Jovin, Tudor G.; Mattle, Heinrich P.; Nogueira, Raul G.; Siddiqui, Adnan H.; Yavagal, Dileep R.; Baxter, Blaise W.; Devlin, Thomas G.; Lopes, Demetrius K.; Reddy, Vivek K.; ... (2015). Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke. New England journal of medicine NEJM, 372(24), pp. 2285-2295. Massachusetts Medical Society MMS 10.1056/NEJMoa1415061 <http://dx.doi.org/10.1056/NEJMoa1415061Test>
BACKGROUND: Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome.METHODS: We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group). Patients had confirmed occlusions in the proximal anterior intracranial circulation and an absence of large ischemic-core lesions. The primary outcome was the severity of global disability at 90 days, as assessed by means of the modified Rankin scale (with scores ranging from 0 [no symptoms] to 6 [death]).RESULTS: The study was stopped early because of efficacy. At 39 centers, 196 patients underwent randomization (98 patients in each group). In the intervention group, the median time from qualifying imaging to groin puncture was 57 minutes, and the rate of substantial reperfusion at the end of the procedure was 88%. Thrombectomy with the stent retriever plus intravenous t-PA reduced disability at 90 days over the entire range of scores on the modified Rankin scale (PCONCLUSIONS: In patients receiving intravenous t-PA for acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, thrombectomy with a stent retriever within 6 hours after onset improved functional outcomes at 90 days. (Funded by Covidien; SWIFT PRIME ClinicalTrials.gov number, NCT01657461.).
