Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: A randomized care trial - 15/12/17
, Tim E. Darsaut b , Jimmy Ghostine a , Yan Deschaintre c , Nicole Daneault c , André Durocher c , Sylvain Lanthier c , Alexandre Y. Pope c , Céline Odier c , Louise-Hélène Lebrun c , François Guilbert a , Jean-Christophe Gentric a, d , André Batista a , Alain Weill a , Daniel Roy a , Serge Bracard e , Jean Raymond a, ⁎ for the EASI trial collaborators
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Abstract |
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≤5h 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 transformation 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.
Le texte complet de cet article est disponible en PDF.Keywords : Acute stroke, Endovascular treatment, Thrombectomy, Randomized clinical trial
Abbreviations : NIHSS, MCA, ICA, ACA, CT, MR, TICI
Plan
Vol 44 - N° 3
P. 198-202 - juin 2017 Retour au numéro
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