近日，一篇发表于国际杂志New England Journal of Medicine上的研究论文中，来自皇家墨尔本医院的研究人员通过研究开展了一项名为EXTEND-IA的大型随机临床研究，旨在揭示一种治疗中风的新疗法的作用。文章中研究者将一种名为支架血栓切除术的微创凝块移除步骤加入到了标准的凝块溶解疗法（名为组织纤溶酶原激活剂，tPA）中，Bruce Campbell表示，我们发现新型疗法可以有效改善血流回流到大脑的效率，这在临床上对于中风的恢复至关重要。

　　研究者表示，当进行凝块移除疗法后89%的患者血流回流到大脑中都得到了恢复，而仅仅使用标准的凝块溶解疗法仅可使34%的患者获益；将支架血栓切除术同标准的凝块溶解疗法结合后可以帮助71%的患者恢复独立生活的能力，而单独的标准疗法则仅能恢复40%患者独立生存的能力。

　　这种新型疗法或可帮助改善严重中风患者的疾病症状，或将明显降低病情给患者带来的负担，缺血性发作是中风的常见形式，其往往是由于血凝块阻断了供给大脑血液的血管而致；而中风也是引发成年个体残疾的主要原因，其也是全球引发个体死亡的第二大主要原因。

　　研究者Mitchell教授指出，治疗中风过程中最重要的就是尽可能恢复患者大脑的血液供给，而EXTEND-IA项目中进行治疗的患者都得到了不错的治疗效果，要优于此前MR-CLEAN项目中患者的治疗情况；两个项目的关键差异在于后者项目中的新型疗法明显打开了患者机体阻断的血管，而且研究人员也对患者进行了早期治疗并且利用先进的脑部成像技术来对患者的治疗效果进行监测。

　　这种名为支架血栓切除术的新型疗法可以通过血管造影片来实现最小化侵入，而EXTEND-IA项目的研究揭示出新型支架血栓切除术对中风患者，尤其是缺血性发作患者的明显治疗效果，如今研究者面对的挑战是如何将支架血栓切除术作为标准疗法来进行中风的治疗。

　　doi:10.1056/NEJMoa1414792
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　　Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection

　　Bruce C.V. Campbell, M.D., Peter J. Mitchell, M.D., Timothy J. Kleinig, M.D., Helen M. Dewey, M.D., Leonid Churilov, Ph.D., Nawaf Yassi, M.D., Bernard Yan, M.D., Richard J. Dowling, M.D., Mark W. Parsons, M.D., Thomas J. Oxley, M.D., Teddy Y. Wu, M.D., Mark Brooks, M.D., Marion A. Simpson, M.D., Ferdinand Miteff, M.D., Christopher R. Levi, M.D., Martin Krause, M.D., Timothy J. Harrington, M.D., Kenneth C. Faulder, M.D., Brendan S. Steinfort, M.D., Miriam Priglinger, M.D., Timothy Ang, M.D., Rebecca Scroop, M.D., P. Alan Barber, M.D., Ben McGuinness, M.D., Tissa Wijeratne, M.D., Thanh G. Phan, M.D., Winston Chong, M.D., Ronil V. Chandra, M.D., Christopher F. Bladin, M.D., Monica Badve, M.D., Henry Rice, M.D., Laetitia de Villiers, M.D., Henry Ma, M.D., Patricia M. Desmond, M.D., Geoffrey A. Donnan, M.D., and Stephen M. Davis, M.D. for the EXTEND-IA Investigators

　　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. Full Text of Background... 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 ischemic 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 tissue and ischemic core of less than 70 ml on computed tomographic (CT) perfusion imaging. The coprimary outcomes were reperfusion at 24 hours and early neurologic improvement (≥8-point reduction on the National Institutes of Health Stroke Scale or a score of 0 or 1 at day 3). Secondary outcomes included the functional score on the modified Rankin scale at 90 days. Full Text of Methods... RESULTS The trial was stopped early because of efficacy after 70 patients had undergone randomization (35 patients in each group). The percentage of ischemic territory that had undergone reperfusion at 24 hours was greater in the endovascular-therapy group than in the alteplase-only group (median, 100% vs. 37%; P<0.001). Endovascular therapy, initiated at a median of 210 minutes after the onset of stroke, increased early neurologic improvement at 3 days (80% vs. 37%, P=0.002) and improved the functional outcome at 90 days, with more patients achieving functional independence (score of 0 to 2 on the modified Rankin scale, 71% vs. 40%; P=0.01). There were no significant differences in rates of death or symptomatic intracerebral hemorrhage. Full Text of Results... CONCLUSIONS In patients with ischemic stroke with a proximal cerebral arterial occlusion and salvageable tissue on CT perfusion imaging, early thrombectomy with the Solitaire FR stent retriever, as compared with alteplase alone, improved reperfusion, early neurologic recovery, and functional outcome. (Funded by the Australian National Health and Medical Research Council and others; EXTEND-IA ClinicalTrials.gov number, NCT01492725, and Australian New Zealand Clinical Trials Registry number, ACTRN12611000969965.)