Por Flavio Carvalho e Maramelia Miranda
Direto de Nashville – International Stroke Conference 2015!!!!!
O ESCAPE Trial foi apresentado hoje, com acesso online simultâneo na homepage da NEJM… Covidien (patrocinadora do trial) comemorando… A apresentação do primeiro slide no centro de convenções, aplaudida.
A seguir, foram apresentados os estudos EXTEND IA e Swift Prime, todos POSITIVOS para a terapia endovascular em agudos com AVCi. Depois mais resultados do MR CLEAN que havia sido apresentado no ano passado. A reação da plateia, cansada de anos e anos com estudos negativos na área, foi eufórica, com aplausos, e mais aplausos…
Portanto, nós neurologistas também ficamos muito felizes com novas evidências, mais uma opção do que fazer para os nossos pacientes!!!!!!!
Vejam os detalhes do ESCAPE, e abaixo os links dos outros 3 estudos de neurointervenção:::::: (corram, não sei quanto tempo os papers vão ficar com acesso free na revista)
BACKGROUND. Among patients with a proximal vessel occlusion in the anterior circulation, 60 to 80% of patients die within 90 days after stroke onset or do not regain functional independence despite alteplase treatment. We evaluated rapid endovascular treatment in addition to standard care in patients with acute ischemic stroke with a small infarct core, a proximal intracranial arterial occlusion, and moderate-to-good collateral circulation.
METHODS. We randomly assigned participants to receive standard care (control group) or standard care plus endovascular treatment with the use of available thrombectomy devices (intervention group). Patients with a proximal intracranial occlusion in the anterior circulation were included up to 12 hours after symptom onset. Patients with a large infarct core or poor collateral circulation on computed tomography (CT) and CT angiography were excluded. Workflow times were measured against predetermined targets. The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. A proportional odds model was used to calculate the common odds ratio as a measure of the likelihood that the intervention would lead to lower scores on the modified Rankin scale than would control care (shift analysis).
RESULTS. The trial was stopped early because of efficacy. At 22 centers worldwide, 316 participants were enrolled, of whom 238 received intravenous alteplase (120 in the intervention group and 118 in the control group). In the intervention group, the median time from study CT of the head to first reperfusion was 84 minutes. The rate of functional independence (90-day modified Rankin score of 0 to 2) was increased with the intervention (53.0%, vs. 29.3% in the control group; P<0.001). The primary outcome favored the intervention (common odds ratio, 2.6; 95% confidence interval, 1.7 to 3.8; P<0.001), and the intervention was associated with reduced mortality (10.4%, vs. 19.0% in the control group; P=0.04). Symptomatic intracerebral hemorrhage occurred in 3.6% of participants in intervention group and 2.7% of participants in control group (P=0.75).
CONCLUSIONS. Among patients with acute ischemic stroke with a proximal vessel occlusion, a small infarct core, and moderate-to-good collateral circulation, rapid endovascular treatment improved functional outcomes and reduced mortality. (Funded by Covidien and others; ESCAPE ClinicalTrials.gov number, NCT01778335.)
LINKS dos Estudos (artigos)