加拿大卡尔加里大学Michael D. Hill团队研究了血管内治疗中血管闭塞所致脑卒中的疗效。2025年2月5日出版的《新英格兰医学杂志》发表了这项成果。

血管内血栓切除术（EVT）治疗大血管闭塞性卒中的大效应规模是否适用于中血管闭塞性中风尚不清楚。

在一项多中心、前瞻性、随机、开放标签、盲法结果评估的试验中，研究组将中血管闭塞引起的急性缺血性卒中患者分配至接受EVT加常规护理或单独常规护理，卒中在最后一次已知健康后12小时内出现，并且基线无创脑成像良好。主要结局是90天时改良Rankin量表评分（范围为0[无症状]至6[死亡]），报告评分为0或1的患者百分比。

2022年4月至2024年6月，来自五个国家的530名患者被纳入研究，其中255名患者被分配到EVT组，275名患者被分到常规护理组。大多数患者（84.7%）的大脑中动脉分支存在原发性闭塞。在90天时，EVT组255名患者中有106名（41.6%）的改良Rankin量表评分为0或1，而常规护理组274名患者中则有118名（43.1%）（校正后的比率为0.95；95%置信区间[CI]为0.79至1.15；P=0.61）。EVT组90天时的死亡率为13.3%，常规护理组为8.4%（调整后的风险比为1.82；95%置信区间为1.06至3.12）。EVT组257名患者中有14名（5.4%）出现症状性颅内出血，而常规护理组272名患者中则有6名（2.2%）。

研究结果表明，由于中血管闭塞在12小时内导致的急性缺血性卒中的血管内治疗，在90天内没有比常规护理产生更好的预后。

附：英文原文

Title: Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion

Author: Mayank Goyal, Johanna M. Ospel, Aravind Ganesh, Dar Dowlatshahi, David Volders, Markus A. Mhlenbruch, Mouhammad A. Jumaa, Shahid M. Nimjee, Thomas C. Booth, Brian H. Buck, James Kennedy, Jai J. Shankar, Franziska Dorn, Liqun Zhang, Christian Hametner, Sandor Nardai, Atif Zafar, William Diprose, Shabnam Vatanpour, Alexander Stebner, Salome Bosshart, Nishita Singh, Ivy Sebastian, Kazutaka Uchida, Karla J. Ryckborst, Robert Fahed, Sherry X. Hu, Dominik F. Vollherbst, Syed F. Zaidi, Vivien H. Lee, Jeremy Lynch, Jeremy L. Rempel, Rachel Teal, Anurag Trivedi, Felix J. Bode, Ayokunle Ogungbemi, Mirko Pham, Peter Orosz, Mohamad Abdalkader, Christian Taschner, Jason Tarpley, Sven Poli, Ravinder-Jeet Singh, Reade De Leacy, George Lopez, Demetrios Sahlas, Michael Chen, Paul Burns, Joanna D. Schaafsma, Richard Marigold, Arno Reich, Adewumi Amole, Thalia S. Field, Richard H. Swartz, Fabio Settecase, Gábor Lenzsér, Santiago Ortega-Gutierrez, Negar Asdaghi, Kyriakos Lobotesis, Adnan H. Siddiqui, Joerg Berrouschot, Maxim Mokin, Koji Ebersole, Hauke Schneider, Albert J. Yoo, Jennifer Mandzia, Jesse Klostranec, Changez Jadun, Tufail Patankar, Eric Sauvageau, Robert Lenthall, Lissa Peeling, Thien Huynh, Ronald Budzik, Seon-Kyu Lee, Levansri Makalanda, Michael R. Levitt, Richard J. Perry, Thant Hlaing, Babak S. Jahromi, Paul Singh, Andrew M. Demchuk, Michael D. Hill

Issue&Volume: 2025-02-05

Abstract:

BACKGROUND

Whether the large effect size of endovascular thrombectomy (EVT) for stroke due to large-vessel occlusion applies to stroke due to medium-vessel occlusion is unclear.

METHODS

In a multicenter, prospective, randomized, open-label trial with blinded outcome evaluation, we assigned patients with acute ischemic stroke due to medium-vessel occlusion who presented within 12 hours from the time that they were last known to be well and who had favorable baseline noninvasive brain imaging to receive EVT plus usual care or usual care alone. The primary outcome was the modified Rankin scale score (range, 0 [no symptoms] to 6 [death]) at 90 days, reported as the percentage of patients with a score of 0 or 1.

RESULTS

A total of 530 patients from five countries were enrolled between April 2022 and June 2024, with 255 patients assigned to the EVT group and 275 to the usual-care group. Most patients (84.7%) had primary occlusions in a middle-cerebral-artery branch. A modified Rankin scale score of 0 or 1 at 90 days occurred in 106 of 255 patients (41.6%) in the EVT group and in 118 of 274 (43.1%) in the usual-care group (adjusted rate ratio, 0.95; 95% confidence interval [CI], 0.79 to 1.15; P=0.61). Mortality at 90 days was 13.3% in the EVT group and 8.4% in the usual-care group (adjusted hazard ratio, 1.82; 95% CI, 1.06 to 3.12). Symptomatic intracranial hemorrhage occurred in 14 of 257 patients (5.4%) in the EVT group and in 6 of 272 (2.2%) in the usual-care group.

CONCLUSIONS

Endovascular treatment for acute ischemic stroke due to medium-vessel occlusion within 12 hours did not lead to better outcomes at 90 days than usual care.

DOI: NJ202502050000003

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2411668