NEJM: Direct thrombosis across the thrombotic after cerebral infarction, which is expected to rewrite clinical guidelines

On May 7, professor Liu Jianmin, director of neurosurgery at Changhai Hospital affiliated with the Naval Medical University, led the topic "Evaluation of the efficacy of direct arterial therapy for acute large vascular blocking ischemic stroke in China: a forward-looking multicenter randomized controlled study", published online in the New England Journal of Medicine, the world's highest influence factor, caused a sensation in the academic circles at home and abroadProfessor Craig Anderson,internationally renowned cerebrovascular disease specialist and former chairman of the Asia-Pacific Stroke Agency, said: "This study opens up a new world of acute ischemic stroke treatment, with very high quality of research and a new benchmark for the execution of future clinical researchProfessor Xiao Ruiping, deputy editor of theNew England Journal of Medicine and executive editor of NEJM Medicine Frontiers, said: "In recent years, the quality of clinical research in the field of stroke in China has greatly improved, several studies have been among the world's advanced, and DIRECT-MT led by Professor Liu Jianmin was published in NEJM, marking the high recognition of the results of the research by peers around the world."1a bold and productive "Chinese original"stroke, stroke, stroke, cerebrovascular accident, is an acute cerebrovascular disease, acute ischemic stroke (commonly known as "brain infarction") caused by cerebral thrombosis is the most common type of stroke, accounting for about three quarters of the stroke in ChinaIn the face of the "brain infarction" of the world's problems, countries are also racking their brains, in recent years, it is generally recommended to use the standard treatment of thrombosis and then take the hydrantbut due to the inherent discipline division, poor regional referral, lack of adequate understanding of patients and other restrictions, the integration of venous thrombosis, arterial thrombosis in the actual operation process is not very ideal, greatly affecting the treatment effect"dare to break the routine and try to get a bolt directly", said Professor Wang Yide, president of the Chinese Society of Preventive Medicine and a member of the Chinese Academy of Engineering, commenting on the innovative design of the clinical study, "which contributes to the long-term progress of the diagnosis and treatment of cerebrovascular diseases in China." "
the subject group selected patients with acute large vascular proteomics whose incidence was suitable for venous thrombosis within 4.5 hours, and were randomly assigned to the individual direct intravascular mechanical thrombosis treatment group (referred to as the direct thrombosis group) and the intravenous drug Atepaselysoconthal and then arterial thrombosis group (referred to as the joint treatment group) to assess the differences between the two methods" is like a house pipe blocked, do you use melting agent first to clear the pipe and then pull out, or directly with a hook to pull out the blockageProfessor Liu Jianmin made an analogy, "Doctors can choose according to the existing conditions of the way to quickly smooth the pipeline, this study for stroke patients to use the best treatment of the best possible thinking." the group screened a total of 1586 patients, and finally 656 cases were included in the study, of which 327 were randomly assigned to the direct embolism group and 329 cases were assigned to the joint treatment group The results showed that direct thrombosis treatment was no worse than arterial thrombosis treatment after intravenous thrombosis drug: the successful recombination rate of blood vessels was lower than that of the joint treatment group by 5.1%, and the difference was not obvious, while the patient mortality rate was lower than 1.1% in the joint treatment group within 90 days the results of the study is expected to further simplify the existing stroke treatment process, improve the efficiency of acute large vascular reclusorying ischemic stroke treatment, relative to traditional therapies, patients if they choose to take direct hydrant, more saving treatment time, the cost is also reduced Based on close international cooperation, all trials were conducted by Chinese doctors in China, greatly enriching and perfecting the case database of Asian semen and contributing Chinese wisdom and strength to the diagnosis and treatment of acute stroke in the world 2
Asked for the hard work of top medical academic journals
Since 2016, Professor Liu Jianmin led the team to boldly break, change, bury their heads, and cooperate with the Dutch MR CLEAN team, agreed to launch similar studies in Both Countries to explore whether patients with acute cerebral infarction caused by intracranial aortic agate can cross venous embolism for direct embolism treatment , with the guidance of the National Health and Health Commission and Wu Tianping Foundation, they selected 41 domestic units with rich experience in hydrant, such as Zhejiang University, Jilin University, Henan Provincial People's Hospital, Nanjing Gulou Hospital in Jiangsu Province, as clinical trial centers, carefully polished research programs, after nearly two years of preparation, in February 2018 to achieve the first patient into the group, the last patients in July 2019 to complete the final patient sending into the group, the same year completed all patient follow-up work it is understood that the topic pioneered clinical research in the field of neural intervention in China in the form of original writings published in the New England Journal of Medicine for this moment of high-gloss, they initially followed extremely strict standards: to establish the first nuclear imaging interpretation standardized core laboratory, the construction of the first set of standardized clinical follow-up interpretation system based on Chinese habits; set up a third-party research advisory committee, data security and monitoring committee, invited the world's most authoritative experts in the field to guide and supervise the project, build an international website, timely release of research dynamics, data open and transparent traceable source; "The implementation of this project has been more efficient and successful than ever before, and the results will change the state of stroke treatment around the world
," said Professor Charles Majoie, of the Medical Research Centre at the University of Amsterdam in the Netherlands, 3 always practice the "time is life" of the golden rule
stroke is today affecting human health, the common concern of all countries of serious diseases, but also one of the most common clinical acute and critical diseases According to monitoring results over the past 20 years, China's death from stroke is more than 2 million a year, and with an annual growth rate of nearly 9%, it has become the number one killer of the country's cause of death, the number one cause of disability among adults in order to improve the cure rate, reduce the disability rate, optimize the cost of diagnosis and treatment, Changhai Hospital Liu Jianmin team has always adhered to the "patient first, standardized innovation" concept, has taken the lead in the establishment of a "one-stop service" stroke screening and prevention base, the establishment of the first full-time stroke first aid nurse team, set a patient from admission to treatment time stability in 20 minutes or so of the miracle .. They were running on their way to time with the sick Professor Liu Jianmin believes that opportunities and challenges coexist, the current domestic treatment of cerebrovascular diseases in the modern technical equipment and the United States, Germany, Australia and other Western developed countries are similar, but the smooth and effective stroke treatment unit access rate is less than 20%, and the United States as high as more than 70% support and tilt in national policies, talents, funds and so on, especially under the protection of the army's strong executive power advantages, the task force is constantly seeking more collaborators to carry out pre-hospital prevention and treatment, technological breakthroughs, emergency assessment, hospital management, science education and other fields of research " insist edgtos on the motherland, so that more Chinese intellectual heating up the global patients The first author of the paper, Yang Pengfei and Associate Professor Zhang Yongxuan of Changhai Hospital, are full of confidence, "The road to conquering disease is long, but the flower of life is re-blossoming forward." "