This article is original from Translational Medicine Network. Please indicate the source when reprinting
Author: Lily
Introduction : On the morning of October 13, the top international medical academic journal "The New England Journal of Medicine 7" released clinical research results for the treatment of stroke . The research paper titled: Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion. This study conducted a prospective, multi-center, randomized controlled study on the effectiveness and safety of arterial thrombectomy in the treatment of acute basal artery occlusion. The research results show that patients with acute basal artery occlusion can benefit from arterial thrombectomy within 12 hours of onset; compared with the best drug treatment, arterial thrombectomy can significantly improve patients' self-care ability and reduce mortality.
research team is led by Chief physician of Neurology Department of Hu Wei , First Affiliated Hospital of the University of Science and Technology of China ( Anhui Provincial Hospital ), and Professor Liu Xinfeng , Deputy Dean of the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital), and Professor Liu Xinfeng , General Hospital of the Eastern Theater Command. Professor Qureshi from the University of Missouri Stroke Center and Professor Nogueira from the Department of Neurology and Neurosurgery at the University of Pittsburgh School of Medicine participated in the research. This study (ATTENTENT) uses Chinese data to answer the global stroke problem of the best treatment method for acute basal artery occlusion. provides important inspiration for the future research direction of acute basal artery occlusion, and is of great significance to the stroke prevention and treatment cause in my country and even the world.
https://www.nejm.org/doi/full/10.1056/NEJMoa2206317
Artificial thrombectomy treatment prognosis is significantly better than the best drug treatment
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stroke commonly known as " stroke ", it is the "number one killer" that endangers life and health. In my country, at least 1 of every 5 deaths died of stroke. Data from the latest "China Stroke Report 2020" released by shows that the number of new strokes in my country is currently about 3.94 million, and the number of deaths reaches 2.19 million, which has put a heavy burden on society and families.
Among all types of strokes, posterior circulation stroke accounts for about one-fifth. Among them, the prognosis of posterior circulation infarction formed by acute basal artery occlusion is often worse than that of anterior circulation large vessel occlusion, and the patient's mortality and disability rate is higher. However, due to the lack of high-quality evidence-based medical evidence, the international medical community has not obtained relevant evidence to test the effectiveness and safety of arterial thrombectomy treatment in patients with stroke caused by acute basal artery occlusion. This ATTENTENT study uses high-quality evidence-based medical evidence to prove that for acute basal artery occlusion, the prognosis of patients in the arterial thrombectomy treatment group is significantly better than that of the optimal drug treatment group. A total of 340 patients (severe ischemic stroke caused by basal artery occlusion and were randomly assigned to the arterial thrombectomy + drug treatment group and the best drug treatment group at a ratio of 2:1. Finally, 226 and 114 people in the thrombectomy and control group were included in the analysis, respectively. The mean age of the study population was 66.5 years, the median baseline NIHSS score (neurological deficit score) was 24 points, and the median time from onset to randomization was about 5 hours. In the arterial thrombolysis treatment group and the control group, 31% and 34% of patients received intravenous thrombolysis treatment, respectively. The main outcome set by the
study was good functional status 90 days after treatment, which was defined as a modified Rankin scale score of 0-3 points (0 points represent symptoms, and 3 points represent moderate disability). The secondary outcome was that the modified Rankin scale score was 0-2 at 90 days after treatment. The safety outcomes included symptomatic intracranial hemorrhage, and another safety outcome was mortality within 90 days.The comparison results of related are shown below:
Image source: "New England Journal of Medicine"
ATTENTENT research results prove that refers to the modified Rankin scale (mRS) that measures the neurologic recovery status of patients after stroke. The proportion of patients in the acute basal artery occlusion and thrombectomy treatment group who have a better prognosis within 90 days is significantly better than the optimal drug treatment group. Among all the secondary outcomes, the thrombectomy treatment group also had significant advantages, among which the proportion of patients with the thrombectomy treatment group had significantly better independent living ability than the control group, and the benefit ratio was comparable to the benefits of the best drug treatment compared with the anterior circulation endovascular treatment. In addition, the thrombectomy treatment group also showed a lower risk of death within 90 days.
authors concluded that for Chinese patients who have basal artery stroke and visit within 12 hours after basal artery occlusion, combined with endovascular thrombectomy and optimal treatment can improve the functional outcome at 90 days, but combined treatment is related to intracranial hemorrhage.
Comments from collaborators
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Professor Qureshi, University of Missouri Stroke Center, USA: This study is a large clinical trial and is of great significance to the treatment of patients with acute ischemic stroke with basal artery occlusion. It is estimated that about 1 million people worldwide suffer from acute basal artery occlusion; the results of this trial confirm that patients with confirmed basal artery occlusion and moderate to severe neurological defects can obtain great therapeutic benefits from endovascular surgery if they can be admitted to the hospital within 12 hours after the onset of symptoms. predicts that the results of this trial will change existing diagnostic and treatment guidelines and may even rewrite guidelines on how to reduce the mortality and disability rates of such extremely severe acute ischemia stroke .
Professor Nogueira, Department of Neurology and Neurosurgery, University of Pittsburgh Medical School: Congratulations to everyone on their outstanding completion of all work during the implementation of the ATTENTENT randomized trial and the ATTENTENT registration study. Our data will surely bring significant changes to the treatment of the most dangerous diseases in the field of neuroscience . Patients with basal artery occlusion can now finally get definitive treatment. Through treatment, we can not only improve the quality of life of patients, but also save lives! This is unprecedented and is of great significance even in treatments that are as effective as thrombectomy. The entire trial project was carefully planned perfectly - from the efficient recruitment of subjects to the strong entry criteria for determining whether outpatients have the qualification to be selected for trials, everything went smoothly. This has also changed the lives of many stroke patients around the world. We are deeply grateful for this!
Reference materials:
https://www.nejm.org/doi/full/10.1056/NEJMoa2206317
https://www.ahslyy.com.cn/cn/News/info_94_itemid_92141.html
Note: This article aims to introduce the progress of medical research and cannot be used as a reference for treatment plans. If you need health guidance, please go to a regular hospital for treatment.
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