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Endovascular Therapy Versus Medical Management for Large Ischemic Infarct: 1-Year Outcomes of the ANGEL-ASPECT Trial

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机构: [1]Capital Med Univ, Beijing Anzhen Hosp, Neurol Dis Ctr, Cerebrovascular Dis Dept, Beijing, Peoples R China [2]Capital Med Univ, Beijing Xuanwu Hosp, Dept Neurol, Beijing, Peoples R China [3]Capital Med Univ, Beijing Luhe Hosp, Dept Neurol, Beijing, Peoples R China [4]Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, Intervent Neuroradiol, 119 S 4th Ring W Rd, Beijing 100070, Peoples R China [5]Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, 119 S 4th Ring W Rd, Beijing 100070, Peoples R China [6]China Natl Clin Res Ctr Neurol Dis, Beijing, Peoples R China [7]Boston Med Ctr, Dept Neurol, Radiol, Boston, MA USA [8]Xiangtan Cent Hosp, Dept Emergency, Xiangtan, Hunan, Peoples R China [9]Linyi Peoples Hosp, Dept Neurol, Linyi, Shandong, Peoples R China [10]Fujian Med Univ, Union Hosp, Dept Neurol, Fuzhou, Peoples R China [11]Tianjin Huanhu Hosp, Dept Neurosurg, Tianjin, Peoples R China [12]Anyang Peoples Hosp, Dept Neurol, Anyang, Henan, Peoples R China [13]Yijishan Hosp, Wannan Med Coll, Dept Neurol, Wuhu, Anhui, Peoples R China [14]First Peoples Hosp Chenzhou, Dept Neurol, Chenzhou, Hunan, Peoples R China [15]Yancheng Third Peoples Hosp, Dept Neurol, Yancheng, Jiangsu, Peoples R China [16]Lishui Municipal Cent Hosp, Dept Neurol, Lishui, Zhejiang, Peoples R China [17]Jilin Univ, China Japan Union Hosp, Dept Neurol, Jilin, Peoples R China [18]Dalian Univ Technol, Dalian Municipal Cent Hosp, Dept Neurointervent, Dalian, Liaoning, Peoples R China [19]Hebei Med Univ, Hosp 1, Dept Neurosurg, Shijiazhuang, Peoples R China [20]Zhongshan City Peoples Hosp, Dept Neurol, Zhongshan 528403, Guangdong, Peoples R China [21]Shantou Cent Hosp, Dept Neurol, Shantou, Guangdong, Peoples R China [22]Nanyang Cent Hosp, Dept Neurol, Nanyang, Henan, Peoples R China [23]Taizhou Hosp Zhejiang Prov, Dept Neurol, Taizhou, Zhejiang, Peoples R China [24]Liaocheng Peoples Hosp, Dept Neurosurg, Liaocheng, Shandong, Peoples R China [25]Baotou Cent Hosp, Dept Neurol, Baotou, Inner Mongolia, Peoples R China [26]Maoming Peoples Hosp, Dept Neurol, Maoming, Guangdong, Peoples R China [27]Guangzhou Med Univ, Affiliated Hosp 2, Dept Neurol, Guangzhou, Guangdong, Peoples R China [28]Zhengzhou Univ, Henan Prov Peoples Hosp, Dept Cerebrovascular Dis, Zhengzhou, Peoples R China [29]Chongqing Med Univ, Dept Neurol, Yongchuan Hosp, Chongqing, Peoples R China [30]South West Med Univ, Affiliated Hosp, Dept Neurol, Luzhou, Sichuan, Peoples R China [31]Shanxi Prov Peoples Hosp, Dept Neurol, Taiyuan, Shanxi, Peoples R China [32]Second Affiliated Hosp, Xiamen Med Coll, Dept Neurol, Fujian 361000, Peoples R China [33]Shengli Oilfield Cent Hosp, Dept Neurol, Dongying 257034, Shandong, Peoples R China [34]Songyuan Jilin Oil Field Hosp, Dept Neurol, Songyuan, Peoples R China [35]Liaocheng Third Peoples Hosp, Dept Intervent Neuroradiol, Liaocheng, Shandong, Peoples R China [36]Taiyuan Cent Hosp, Dept Neurol, Taiyuan, Peoples R China [37]Jinan Univ, Jiangmen Tradit Chinese Med Hosp, Dept Neurol, Jiangmen, Guangdong, Peoples R China [38]Sichuan Mianyang 404 Hosp, Dept Neurol, Mianyang 621000, Peoples R China [39]Yangzhou Univ, Jingjiang Peoples Hosp, Affiliated Hosp 7, Dept Neurol, Jingjiang, Jiangsu, Peoples R China [40]Tianjin TEDA Hosp, Dept Neurosurg, Tianjin, Peoples R China [41]Sichuan Univ, West China Hosp, Dept Neurol, Chengdu, Peoples R China [42]Shihezi Univ, Affiliated Hosp 1, Sch Med, Dept Neurosurg, Shihezi, Xinjiang, Peoples R China [43]Siping Cent Peoples Hosp, Dept Neurol, Jilin, Peoples R China [44]Mianyang Cent Hosp, Dept Neurol, Mianyang, Guangzhou, Peoples R China [45]Hangzhou First Peoples Hosp, Dept Neurol, Hangzhou, Zhejiang, Peoples R China [46]Guizhou Med Univ, Affiliated Hosp, Dept Neurosurg, Guiyang, Guizhou, Peoples R China
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关键词: caregivers infarction ischemic stroke prognosis thrombectomy

摘要:
BACKGROUND: Several trials have shown the benefit and safety of endovascular therapy (EVT) compared with medical management (MM) of patients with a large ischemic core in the 90-day follow-up. However, the 1-year outcome comparison between EVT and MM in Asian patients with a large ischemic core has not been investigated. Our aim was to evaluate the 1-year outcomes of patients in the ANGEL-ASPECT trial (Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core). METHODS: In this phase 3, randomized, open-label, blinded end point assessment trial, patients with anterior circulation large vessel occlusion and an Alberta Stroke Program Early CT Score of 3 to 5 or an infarct core volume of 70 to 100 mL were enrolled across 46 hospitals in China. Patients were randomly assigned 1:1 to EVT or MM. The 90-day outcomes were previously reported. We report a prespecified analysis of the ANGEL-ASPECT trial, with 1-year functional outcome as the primary outcome in this study. The primary outcome was the shift of the modified Rankin Scale (mRS) score (range, 0-6, with a higher score reflecting greater disability) to better outcomes at 1-year. The secondary outcomes included functional independence (mRS score, 0-2), independent ambulation (mRS score, 0-3), and mortality. This trial is registered with https://www.clinicaltrials.gov (Unique identifier: NCT04551664). RESULTS: One-year data were available for 425 of 455 (93%) patients for the primary outcome, with 214 patients in the EVT group and 211 in the MM group in the complete case analysis. The mean age was 66 years, and 38.1% were female. There was a greater likelihood of shift toward improved 1-year mRS distribution in the EVT compared with the MM group (generalized odds ratio, 1.25 [95% CI, 1.01-1.56]; P=0.04). Functional independence and independent ambulation were higher in the EVT compared with MM groups (mRS score, 0-2: 30.4% [65/214] versus 17.1% [36/211]; relative risk, 1.87 [95% CI, 1.27-2.75]; mRS score, 0-3: 50.0% [107/214] versus 35.6% [75/211]; relative risk, 1.46 [95% CI, 1.15-1.85], respectively). The 1-year mortality rate was 31.3% (67/214) in the EVT group and 26.5% (56/211) in the MM group (relative risk, 1.12 [95% CI, 0.82-1.53]). In addition, no change was found in the rate of functional independence between 90 days and 1 year in the EVT group (29.4% [69/214] versus 30.4% [65/214], respectively); however, a gain in functional independence was observed in the MM group from 90 days to 1 year (10.9% [26/211] versus 17.1% [36/211]), narrowing the magnitude of EVT treatment effect from 18.5% at 90 days to 13.3% at 1 year. CONCLUSIONS: In patients with large ischemic stroke from a proximal arterial occlusion presenting within 24 hours of onset, EVT reduced disability with durable 1-year benefit compared with MM.

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出版当年[2025]版:
大类 | 1 区 医学
小类 | 1 区 临床神经病学 1 区 外周血管病
最新[2025]版:
大类 | 1 区 医学
小类 | 1 区 临床神经病学 1 区 外周血管病
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出版当年[2023]版:
Q1 CLINICAL NEUROLOGY Q1 PERIPHERAL VASCULAR DISEASE
最新[2024]版:
Q1 CLINICAL NEUROLOGY Q1 PERIPHERAL VASCULAR DISEASE

影响因子: 最新[2024版] 最新五年平均 出版当年[2023版] 出版当年五年平均 出版前一年[2022版] 出版后一年[2024版]

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第一作者机构: [1]Capital Med Univ, Beijing Anzhen Hosp, Neurol Dis Ctr, Cerebrovascular Dis Dept, Beijing, Peoples R China
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通讯机构: [4]Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, Intervent Neuroradiol, 119 S 4th Ring W Rd, Beijing 100070, Peoples R China [5]Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, 119 S 4th Ring W Rd, Beijing 100070, Peoples R China [6]China Natl Clin Res Ctr Neurol Dis, Beijing, Peoples R China
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