TY  - BOOK
AU  - Kidwell, Chelsea S
TI  - A trial of imaging selection and endovascular  treatment for ischemic stroke
SN  - 0028-4793
PY  - 2013///
KW  - *Fibrinolytic Agents/tu [Therapeutic Use]
KW  - *Neuroimaging
KW  - *Stroke/di [Diagnosis]
KW  - *Stroke/su [Surgery]
KW  - *Thrombectomy
KW  - *Tissue Plasminogen Activator/tu [Therapeutic Use]
KW  - Acute Disease
KW  - Adult
KW  - Aged
KW  - Aged, 80 and over
KW  - Analysis of Variance
KW  - Brain/pa [Pathology]
KW  - Brain/ra [Radiography]
KW  - Cerebral Angiography
KW  - Disability Evaluation
KW  - Female
KW  - Humans
KW  - Magnetic Resonance Angiography
KW  - Male
KW  - Middle Aged
KW  - Single-Blind Method
KW  - Stroke/dt [Drug Therapy]
KW  - Thrombectomy/is [Instrumentation]
KW  - Tomography, X-Ray Computed
KW  - MedStar Heart & Vascular Institute
KW  - Clinical Trial, Phase II
KW  - Journal Article
KW  - Multicenter Study
KW  - Randomized Controlled Trial
KW  - Research Support, N.I.H., Extramural
KW  - Research Support, Non-U.S. Gov't
N1  - Available online from MWHC library: 1993 -  present, Available in print through MWHC library: 1980 -  present
N2  - BACKGROUND: Whether brain imaging can identify  patients who are most likely to benefit from therapies for  acute ischemic stroke and whether endovascular thrombectomy  improves clinical outcomes in such patients remains unclear; CONCLUSIONS: A favorable penumbral pattern on  neuroimaging did not identify patients who would  differentially benefit from endovascular therapy for acute  ischemic stroke, nor was embolectomy shown to be superior to  standard care. (Funded by the National Institute of  Neurological Disorders and Stroke; MR RESCUE  ClinicalTrials.gov number, NCT00389467.); METHODS: In this study, we randomly assigned  patients within 8 hours after the onset of large-vessel,  anterior-circulation strokes to undergo mechanical  embolectomy (Merci Retriever or Penumbra System) or receive  standard care. All patients underwent pretreatment computed  tomography or magnetic resonance imaging of the brain.  Randomization was stratified according to whether the  patient had a favorable penumbral pattern (substantial  salvageable tissue and small infarct core) or a nonpenumbral  pattern (large core or small or absent penumbra). We  assessed outcomes using the 90-day modified Rankin scale,  ranging from 0 (no symptoms) to 6 (dead); RESULTS: Among 118 eligible patients, the mean age  was 65.5 years, the mean time to enrollment was 5.5 hours,  and 58% had a favorable penumbral pattern. Revascularization  in the embolectomy group was achieved in 67% of the  patients. Ninety-day mortality was 21%, and the rate of  symptomatic intracranial hemorrhage was 4%; neither rate  differed across groups. Among all patients, mean scores on  the modified Rankin scale did not differ between embolectomy  and standard care (3.9 vs. 3.9, P=0.99). Embolectomy was not  superior to standard care in patients with either a  favorable penumbral pattern (mean score, 3.9 vs. 3.4;  P=0.23) or a nonpenumbral pattern (mean score, 4.0 vs. 4.4;  P=0.32). In the primary analysis of scores on the 90-day  modified Rankin scale, there was no interaction between the  pretreatment imaging pattern and treatment assignment  (P=0.14)
UR  - http://dx.doi.org/10.1056/NEJMoa1212793
ER  -