NEJM: Endovascular therapy combined with thrombolysis in patients with massive acute stroke

Endovascular therapy has become one of the standard treatments for acute stroke
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Guidelines suggest that endovascular therapy should be considered when the M1 main trunk of the cerebral or internal carotid arteries is occluded and imaging shows a moderate infarct size (ASPECTS score of 6 or more) or a volume mismatch between the ischemic core volume and the area of ​​delayed perfusion

Vascular Stroke Guidelines Recently, researchers examined the clinical effects of endovascular therapy combined with usual care in patients with large infarcts

The study was carried out in Japan, and patients with cerebral vascular occlusion stroke with an ASPECTS score of 3 to 5 on early CT assessment participated in the study.
All patients were randomized to receive endovascular treatment or control on the basis of alteplase (0.
6 mg/Kg) treatment
.

The primary endpoint of the study was the proportion of patients with a 90-day modified Rankin score of 0-3, and a secondary endpoint was the proportion of patients with an improved 90-day modified Rankin score of at least 8 points at 48 hours

203 patients participated in the study, including 101 in the endovascular treatment group and 102 in the control group, and 27% of patients in each group received alteplase
.

31.

31.

90-day modified Rankin score between groups

Between-group 90-day modified Rankin score Between-group 90-day modified Rankin score

The endovascular treatment group had a higher proportion of patients with a better 90-day modified Rankin score
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The 48-hour NIHSS scores improved in 31.

Differences in clinical endpoint outcomes between groups

Differences in clinical endpoint outcomes between groups

Studies have shown that thrombolysis combined with endovascular therapy for acute stroke patients with large infarct size is better than thrombolysis alone, but the risk of intracranial hemorrhage increases
.

For acute stroke patients with large vessel occlusion with large infarct size, thrombolysis combined with endovascular therapy is more effective than thrombolysis alone in improving the prognosis of patients, but the risk of intracranial hemorrhage is increased
.

For acute stroke patients with large vessel occlusion with large infarct size, thrombolysis combined with endovascular therapy is more effective than thrombolysis alone in improving the prognosis of patients, but the risk of intracranial hemorrhage is increased

Original source:

Shinichi Yoshimura et al.

Endovascular Therapy for Acute Stroke with a Large Ischemic Region.
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