Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Quick
Summary
BOTTOM
LINE
In
patients
with
acute
ischemic
stroke
from
proximal
intracranial
occlusion
of
arterial
circulation,
intraarterial
treatment
(IAT)
within
6
hours
of
stroke
onset
was
safe
and
effective,
leading
to
an
increase
in
functional
recovery
without
greater
mortality.
.
MAJOR
POINTS
As
a
contrast
to
recent
trials
which
showed
no
beneFit
to
IAT,
this
study
showed
a
clear,
patient-
centered
outcome
of
improved
functional
status
as
a
result
of
if
IAT.
NIH Stroke Scale after 5-7 days 2.9 points lower in the intervention group than the control group.
No
signiFicant
between
group
difference
in
mortality
or
other
severe
adverse
events
during
the
90
day
follow
up.
CRITICISM
Unbalanced
randomization,
with
more
patients
in
the
control
group
than
the
intervention
group.
Addressed
by
stratiFication.
Lower
reperfusion
rate
than
recent
case
series.
May
have
resulted
from
heterogeneity
of
outcome
measures.
Study
design
RANDOMIZED
CONTROL
TRIAL
INCLUSION CRITERIA
Occlusion
of
the
distal
intracranial
carotid
artery,
middle
cerebral
artery
(M1
or
M2),
or
anterior
cerebral
artery
(A1
or
A2).
EXCLUSION
CRITERIA
Purpose
In
patients
with
acute
ischemic
stroke
from
proximal
intracranial
arterial
occlusion,
intraarterial
treatment
will
effectively
revascularize
these
territories.
Prior
to
this
study,
however,
there
has
not
been
a
demonstration
of
a
functional
beneFit
to
the
patient
from
this
revascularization.
Interven7on
Outcome
Shift
in
the
distribution
of
primary
outcome
scores
in
favor
of
the
intervention,
consistent
across
all
categories
of
the
modiFied
Rankin
scale,
except
for
death.
Credits
SUMMARY
BY:
Jeffrey
Barrett
Donaldson,
M.S.,
MS4
College
of
Medicine
SUNY
Upstate
Medical
University
FULL
CITATION:
Berkhemer,
Olvert
A.,
et
al.
"A
randomized
trial
of
intraarterial
treatment
for
acute
ischemic
stroke."
New
England
Journal
of
Medicine
372.1
(2015):
11-20.
Fransen,
Puck
SS,
et
al.
"MR
CLEAN,
a
mul7center
randomized
clinical
trial
of
endovascular
treatment
for
acute
ischemic
stroke
in
the
Netherlands:
study
protocol
for
a
randomized
controlled
trial."
Trials
15.1
(2014):
343.
sirweb.org