Główne pojęcia
Endovascular thrombectomy significantly benefits acute ischemic stroke patients with large vessel occlusion and established large infarcts, as demonstrated by the TENSION trial.
Streszczenie
The TENSION trial showcased the substantial advantages of endovascular thrombectomy in acute ischemic stroke patients with large vessel occlusion and significant infarcts identified through basic imaging techniques. Here is a breakdown of the key points:
Trial Results:
- Thrombectomy led to an 18% increase in patients walking independently at 90 days.
- A mortality reduction of 11% at 90 days compared to medical therapy alone.
- Consistent benefits across all outcome categories and subgroups.
- No safety concerns or increase in intracranial hemorrhage with thrombectomy.
Study Details:
- Trial enrolled 665 patients with large vessel occlusion and extended infarcts.
- Patients randomly assigned to thrombectomy plus medical management or medical management alone.
- Early trial termination due to efficacy after enrolling 253 patients.
Outcome Analysis:
- Thrombectomy associated with better outcomes on the modified Rankin Scale.
- Significant improvement in functional independence and reduced mortality.
- No increase in severe hemorrhage with thrombectomy.
Expert Insights:
- Dr. Thomalla emphasized the life-saving potential of thrombectomy in this patient population.
- Dr. Nguyen highlighted the study's importance in treating patients with large ischemic core based on CT imaging alone.
Editorial Perspective:
- Dippel and Roozenbeek discussed the use of CT perfusion in patient selection for thrombectomy.
- Urged for meta-analyses to define patient populations benefiting from this treatment.
Statystyki
Thrombectomy resulted in an 18% absolute increase in patients walking independently at 90 days.
Mortality reduction of 11% at 90 days with thrombectomy.
Symptomatic intracranial hemorrhage occurred in 6% of patients with thrombectomy.
Cytaty
"This pragmatic approach based on visual assessment of non-contrast CT yielded similar benefit to trials with more complicated and time-consuming imaging approaches." - Götz Thomalla
"In this population, thrombectomy really is saving lives. In this study, it saved the life of 1 patient in every 9 that were treated." - Götz Thomalla