Endovascular thrombectomy after large-vessel ischaemic stroke : a meta-analysis of individual patient data from five randomised trials
| العنوان: | Endovascular thrombectomy after large-vessel ischaemic stroke : a meta-analysis of individual patient data from five randomised trials |
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| المؤلفون: | Goyal, Mayank, Menon, Bijoy, van Zwam, Wim, Dippel, Diederik, Roy, Peter, Demchuk, Andrew, Dávalos, Antoni, Majoie, Charles, van der Lugt, Aad, de Miquel, Maria, Donnan, Geoffrey, Roos, Yvo, Bonafe, Alain, Jahan, Reza, Diener, Hans-Christoph, van den Berg, Lucie, Levy, Elad, Berkhemer, Olvert, Pereira, Vitor, Rempel, Jeremy, Millán, Mònica, Roy, Stephen, Roy, Daniel, Thornton, John, Román, Luis San, Ribo, Marc, Beumer, Debbie, Stouch, Bruce, Brown, Scott, Campbell, Bruce, van Oostenbrugge, Robert, Saver, Jeffrey, Hill, Michael, Jovin, Tudor, Mitchell, Peter, Davis, Stephen |
| المساهمون: | Neurology, Radiology & Nuclear Medicine, RS: CARIM - R3.11 - Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), MUMC+: MA AIOS Neurologie (9), RS: CARIM - R3.03 - Cerebral small vessel disease, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, Graduate School, Hotchkiss Brain Institute, Erasmus University Medical Center [Rotterdam] (Erasmus MC), University of Calgary, Hospital Universitario Germans Trias I Pujol, University of Amsterdam [Amsterdam] (UvA), Departments of Radiology and of Epidemiology [Rotterdam], University of Melbourne, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of California [Los Angeles] (UCLA), University of California, Department of Neurology, University Hospital Essen, University of Minho [Braga], University College London Hospitals (UCLH), Universitat de Barcelona, Universitat de Barcelona (UB), The Royal Melbourne Hospital, Department of Neurology [Maastricht, The Netherlands], Maastricht University Medical Centre - MUMC [Maastricht, The Netherlands], University of Pittsburgh (PITT), Pennsylvania Commonwealth System of Higher Education (PCSHE) |
| المصدر: | Lancet (UK), 387(10029), 1723-1731. Elsevier Ltd. Lancet, 387(10029), 1723-1731. Elsevier Science Lancet, 387(10029), 1723-1731. Elsevier Limited AJNR Am J Neuroradiol The Lancet The Lancet, Elsevier, 2016, 387 (10029), pp.1723-1731. ⟨10.1016/S0140-6736(16)00163-X⟩ |
| سنة النشر: | 2016 |
| مصطلحات موضوعية: | Male, medicine.medical_specialty, Population, Medizin, 030204 cardiovascular system & hematology, Article, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Modified Rankin Scale, Internal medicine, medicine.artery, Occlusion, medicine, Odds Ratio, Humans, education, Stroke, Aged, Randomized Controlled Trials as Topic, Thrombectomy, Aged, 80 and over, education.field_of_study, business.industry, Endovascular Procedures, General Medicine, Odds ratio, Middle Aged, medicine.disease, 3. Good health, Surgery, Treatment Outcome, Tissue Plasminogen Activator, Middle cerebral artery, Cardiology, Female, Internal carotid artery, business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, Fibrinolytic agent, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology |
| الوصف: | International audience; BACKGROUND:In 2015, five randomised trials showed efficacy of endovascular thrombectomy over standard medical care in patients with acute ischaemic stroke caused by occlusion of arteries of the proximal anterior circulation. In this meta-analysis we, the trial investigators, aimed to pool individual patient data from these trials to address remaining questions about whether the therapy is efficacious across the diverse populations included.METHODS:We formed the HERMES collaboration to pool patient-level data from five trials (MR CLEAN, ESCAPE, REVASCAT, SWIFT PRIME, and EXTEND IA) done between December, 2010, and December, 2014. In these trials, patients with acute ischaemic stroke caused by occlusion of the proximal anterior artery circulation were randomly assigned to receive either endovascular thrombectomy within 12 h of symptom onset or standard care (control), with a primary outcome of reduced disability on the modified Rankin Scale (mRS) at 90 days. By direct access to the study databases, we extracted individual patient data that we used to assess the primary outcome of reduced disability on mRS at 90 days in the pooled population and examine heterogeneity of this treatment effect across prespecified subgroups. To account for between-trial variance we used mixed-effects modelling with random effects for parameters of interest. We then used mixed-effects ordinal logistic regression models to calculate common odds ratios (cOR) for the primary outcome in the whole population (shift analysis) and in subgroups after adjustment for age, sex, baseline stroke severity (National Institutes of Health Stroke Scale score), site of occlusion (internal carotid artery vs M1 segment of middle cerebral artery vs M2 segment of middle cerebral artery), intravenous alteplase (yes vs no), baseline Alberta Stroke Program Early CT score, and time from stroke onset to randomisation.FINDINGS:We analysed individual data for 1287 patients (634 assigned to endovascular thrombectomy, 653 assigned to control). Endovascular thrombectomy led to significantly reduced disability at 90 days compared with control (adjusted cOR 2.49, 95% CI 1.76-3.53; p |
| اللغة: | English |
| تدمد: | 0140-6736 0923-7577 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::27619555c54496bfa98beff51b63cd15Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....27619555c54496bfa98beff51b63cd15 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 01406736 09237577 |
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