题名 | Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke |
作者 | Yang, Pengfei1; Zhang, Yongwei1; Zhang, Lei1; Zhang, Yongxin2; Treurniet, Kilian M.38; Chen, Wenhuo7; Peng, Ya8; Han, Hongxing9; Wang, Jiyue10; Wang, Shouchun11; Yin, Congguo12; Liu, Sheng14; Wang, Peng16; Fang, Qi17; Shi, Hongchao15; Yang, Jianhong18; Wen, Changming19; Li, Conghui20; Jiang, Changchun21; Sun, Jun22; Yue, Xincan23; Lou, Min13; Zhang, Meng24; Shu, Hansheng25; Sun, Dianjing26; Liang, Hui27; Li, Tong28; Guo, Fuqiang29; Ke, Kaifu30; Yuan, Haicheng31; Wang, Guoping32; Yang, Weimin33; Shi, Huaizhang34; Li, Tianxiao35; Li, Zifu1; Xing, Pengfei2; Zhang, Ping2; Zhou, Yu1; Wang, Hao9; Xu, Yi1; Huang, Qinghai1; Wu, Tao2; Zhao, Rui1; Li, Qiang1; Fang, Yibin1; Wang, Laixing1; Lu, Jianping3; Li, Yansheng4; Fu, Jianhui5; Zhong, Xihua6; Wang, Yongjun36; Wang, Longde37; Goyal, Mayank41; Dippel, Diederik W.J.40; Hong, Bo1; Deng, Benqiang2; Roos, Yvo B.W.E.M.39; Majoie, Charles B.L.M.38; Liu, Jianmin1
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发表日期 | 2020-05-21 |
发表期刊 | NEW ENGLAND JOURNAL OF MEDICINE 影响因子和分区 |
语种 | 英语 |
原始文献类型 | Article |
其他关键词 | ISCHEMIC-STROKE ; MECHANICAL THROMBECTOMY ; THROMBOLYSIS ; RECANALIZATION ; REPERFUSION ; PREDICTORS ; ADJUSTMENT ; OUTCOMES ; THERAPY |
摘要 | Background In acute ischemic stroke, there is uncertainty regarding the benefit and risk of administering intravenous alteplase before endovascular thrombectomy. Methods We conducted a trial at 41 academic tertiary care centers in China to evaluate endovascular thrombectomy with or without intravenous alteplase in patients with acute ischemic stroke. Patients with acute ischemic stroke from large-vessel occlusion in the anterior circulation were randomly assigned in a 1:1 ratio to undergo endovascular thrombectomy alone (thrombectomy-alone group) or endovascular thrombectomy preceded by intravenous alteplase, at a dose of 0.9 mg per kilogram of body weight, administered within 4.5 hours after symptom onset (combination-therapy group). The primary analysis for noninferiority assessed the between-group difference in the distribution of the modified Rankin scale scores (range, 0 [no symptoms] to 6 [death]) at 90 days on the basis of a lower boundary of the 95% confidence interval of the adjusted common odds ratio equal to or larger than 0.8. We assessed various secondary outcomes, including death and reperfusion of the ischemic area. Results Of 1586 patients screened, 656 were enrolled, with 327 patients assigned to the thrombectomy-alone group and 329 assigned to the combination-therapy group. Endovascular thrombectomy alone was noninferior to combined intravenous alteplase and endovascular thrombectomy with regard to the primary outcome (adjusted common odds ratio, 1.07; 95% confidence interval, 0.81 to 1.40; P=0.04 for noninferiority) but was associated with lower percentages of patients with successful reperfusion before thrombectomy (2.4% vs. 7.0%) and overall successful reperfusion (79.4% vs. 84.5%). Mortality at 90 days was 17.7% in the thrombectomy-alone group and 18.8% in the combination-therapy group. Conclusions In Chinese patients with acute ischemic stroke from large-vessel occlusion, endovascular thrombectomy alone was noninferior with regard to functional outcome, within a 20% margin of confidence, to endovascular thrombectomy preceded by intravenous alteplase administered within 4.5 hours after symptom onset. (Funded by the Stroke Prevention Project of the National Health Commission of the People's Republic of China and the Wu Jieping Medical Foundation; DIRECT-MT ClinicalTrials.gov number, NCT03469206.) |
资助项目 | Stroke Prevention Project of the National Health Commission of the People's Republic of China [GN-2017R0001]; Wu Jieping Medical Foundation |
出版者 | MASSACHUSETTS MEDICAL SOC |
出版地 | WALTHAM |
ISSN | 0028-4793 |
EISSN | 1533-4406 |
卷号 | 382期号:21页码:1981-1993 |
DOI | 10.1056/NEJMoa2001123 |
页数 | 13 |
WOS类目 | Medicine, General & Internal |
WOS研究方向 | General & Internal Medicine |
WOS记录号 | WOS:000536856000013 |
收录类别 | SCIE ; SCOPUS ; PUBMED |
URL | 查看原文 |
PubMed ID | 32374959 |
SCOPUSEID | 2-s2.0-85085290715 |
ESI高被引论文 | 2021-01 ; 2021-03 ; 2021-05 ; 2021-07 ; 2021-11 ; 2022-01 ; 2022-03 ; 2022-07 ; 2022-09 ; 2022-11 ; 2023-01 ; 2023-03 ; 2023-05 ; 2023-07 ; 2023-09 ; 2023-11 ; 2024-01 ; 2024-03 ; 2024-05 ; 2024-07 ; 2024-09 ; 2024-11 |
自科自定义期刊分类 | T1类 |
通讯作者地址 | [Liu, Jianmin]Department of Neurosurgery,Changhai Hospital,168 Changhai Rd,Shanghai,200433,China |
Scopus学科分类 | Medicine (all) |
TOP期刊 | TOP期刊 |
引用统计 | |
文献类型 | 期刊论文 |
条目标识符 | https://kms.wmu.edu.cn/handle/3ETUA0LF/20886 |
专题 | 温州医科大学 |
通讯作者 | Liu, Jianmin |
作者单位 | 1.Department of Neurosurgery,Naval Medical University Changhai Hospital,Shanghai,China; 2.Department of Neurology,Naval Medical University,Changhai Hospital,Shanghai,China; 3.Department of Radiology,Naval Medical University,Changhai Hospital,Shanghai,China; 4.Department of Neurology,Shanghai Jiaotong University Renji Hospital,Shanghai,China; 5.Department of Neurology,Fudan University Huashan Hospital,Shanghai,China; 6.Data Statistics Center,Shanghai KNOWLANDS MedPharm Consulting,Shanghai,China; 7.Department of Neurology,Zhangzhou Affiliated Hospital of Fujian Medical University,Zhangzhou,China; 8.Department of Neurosurgery,Third Affiliated Hospital of Soochow University,Changzhou,China; 9.Department of Neurology,Linyi People’s Hospital of Qingdao University,Linyi,China; 10.Department of Neurosurgery,Liaocheng People’s Hospital of Shandong First Medical University,Liaocheng,China; 11.Department of Neurology,First Affiliated Hospital of Jilin University,Changchun,China; 12.Department of Neurology,Hangzhou First People’s Hospital of Zhejiang University,Hangzhou,China; 13.Department of Neurology,Second Affiliated Hospital of Zhejiang University,Hangzhou,China; 14.Department of Radiology,Jiangsu Provincial People’s Hospital of Nanjing Medical University,Nanjing,China; 15.Department of Neurology,Nanjing First Hospital of Nanjing Medical University,Nanjing,China; 16.Department of Neurology,Taizhou First People’s Hospital of Wenzhou Medical University,Taizhou,China; 17.Department of Neurology,First Affiliated Hospital of Soochow University,Suzhou,China; 18.Department of Neurology,Ningbo Hospital of Zhejiang University,Ningbo,China; 19.Department of Neurology,Nanyang Central Hospital of Xinxiang Medical University,Nanyang,China; 20.Department of Neurosurgery,First Hospital of Hebei Medical University,Shijiazhuang,China; 21.Department of Neurology,Baotou Central Hospital of Inner Mongolia Medical University,Baotou,China; 22.Department of Neurosurgery,Wenzhou Central Hospital of Wenzhou Medical University,Wenzhou,China; 23.Department of Neurosurgery,Zhoukou Central Hospital of Henan University,Zhoukou,China; 24.Department of Neurology,Daping Hospital of Army Medical University,Chongqing,China; 25.Department of Neurosurgery,Second Affiliated Hospital of Bengbu Medical University,Bengbu,China; 26.Department of Radiology,Yantaishan Hospital of Shandong First Medical University,Yantai,China; 27.Department of Neurology,Yantaishan Hospital of Shandong First Medical University,Yantai,China; 28.Department of Neurology,Third Affiliated Hospital of Guangxi Medical University,Nanning,China; 29.Department of Neurology,Sichuan Provincial Hospital of University of Electronic Science and Technology of China,Chengdu,China; 30.Department of Neurology,Affiliated Hospital of Nantong University,Nantong,China; 31.Department of Neurology,Qingdao Central Hospital of Qingdao University,Qingdao,China; 32.Department of Neurology,First Affiliated Hospital of the University of Science and Technology of China,Hefei,China; 33.Department of Neurology,First Affiliated Hospital of Anhui Medical University,Hefei,China; 34.Department of Neurosurgery,First Affiliated Hospital of Harbin Medical University,Harbin,China; 35.Department of Radiology,Henan Provincial People’s Hospital of Zhengzhou University,Zhengzhou,China; 36.Department of Neurology,Capital Medical University,Tiantan Hospital,Beijing,China; 37.School of Public Health,Beijing University,Beijing,China; 38.Department of Radiology and Nuclear Medicine,Amsterdam University Medical Center,Amsterdam,Netherlands; 39.Department of Neurology,Amsterdam University Medical Center,Amsterdam,Netherlands; 40.Department of Neurology,Erasmus MC–University Medical Center,Rotterdam,Netherlands; 41.Department of Radiology and Clinical Neurosciences,University of Calgary,Calgary,Canada |
推荐引用方式 GB/T 7714 | Yang, Pengfei,Zhang, Yongwei,Zhang, Lei,et al. Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke[J]. NEW ENGLAND JOURNAL OF MEDICINE,2020,382(21):1981-1993. |
APA | Yang, Pengfei., Zhang, Yongwei., Zhang, Lei., Zhang, Yongxin., Treurniet, Kilian M.., ... & Liu, Jianmin. (2020). Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. NEW ENGLAND JOURNAL OF MEDICINE, 382(21), 1981-1993. |
MLA | Yang, Pengfei,et al."Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke".NEW ENGLAND JOURNAL OF MEDICINE 382.21(2020):1981-1993. |
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