EXTEND-IA研究.pdf

T h e n e w e ngl a nd j o u r na l o f m e dic i n e n engl j med nejm.org 1 original article Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection B.C.V. Campbell, P.J. Mitchell, T.J. Kleinig, H.M. Dewey, L. Churilov, N. Yassi, B. Yan, R.J. Dowling, M.W. Parsons, T.J. Oxley, T.Y. Wu, M. Brooks, M.A. Simpson, F. Miteff, C.R. Levi, M. Krause, T.J. Harrington, K.C. Faulder, B.S. Steinfort, M. Priglinger, T. Ang, R. Scroop, P.A. Barber, B. McGuinness, T. Wijeratne, T.G. Phan, W. Chong, R.V. Chandra, C.F. Bladin, M. Badve, H. Rice, L. de Villiers, H. Ma, P.M. Desmond, G.A. Donnan, and S.M. Davis, for the EXTEND-IA Investigators* The authors’ full names, academic de- grees, and affiliations are listed in the Ap- pendix. Address reprint requests to Dr. Campbell at the Department of Neurolo- gy, Royal Melbourne Hospital, Grattan St., Parkville, VIC 3050, Australia, or at bruce.campbell@mh.org.au. * A complete list of investigators in the Extending the Time for Thrombolysis in Emergency Neurological Deficits — Intra-Arterial (EXTEND-IA) trial is pro- vided in the Supplementary Appendix, available at NEJM.org. This article was published on February 11, 2015, at NEJM.org. DOI: 10.1056/NEJMoa1414792 Copyright ? 2015 Massachusetts Medical Society. A BS TR AC T Background Trials of endovascular therapy for ischemic stroke have produced variable results. We conducted this study to test whether more advanced imaging selection, recently developed devices, and earlier intervention improve outcomes. Methods We randomly assigned patients with ischemic stroke who were receiving 0.9 mg of alteplase per kilogram of body weight less than 4.5 hours after the onset of ische- mic stroke either to undergo endovascular thrombectomy with the Solitaire FR (Flow Restoration) stent retriever or to continue receiving alteplase alone. All the patients had occlusion of the internal carotid or middle cerebral artery and evidence of salvageable brain