title: Randomized assessment of rapid endovascular treatment of ischemic stroke.
abstract: 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.).
authors: The authors' affiliations are listed in the Appendix.
authors: Mayank
authors: M
authors: Goyal
authors: Andrew M
authors: AM
authors: Demchuk
authors: Bijoy K
authors: BK
authors: Menon
authors: Muneer
authors: M
authors: Eesa
authors: Jeremy L
authors: JL
authors: Rempel
authors: John
authors: J
authors: Thornton
authors: Daniel
authors: D
authors: Roy
authors: Tudor G
authors: TG
authors: Jovin
authors: Robert A
authors: RA
authors: Willinsky
authors: Biggya L
authors: BL
authors: Sapkota
authors: Dar
authors: D
authors: Dowlatshahi
authors: Donald F
authors: DF
authors: Frei
authors: Noreen R
authors: NR
authors: Kamal
authors: Walter J
authors: WJ
authors: Montanera
authors: Alexandre Y
authors: AY
authors: Poppe
authors: Karla J
authors: KJ
authors: Ryckborst
authors: Frank L
authors: FL
authors: Silver
authors: Ashfaq
authors: A
authors: Shuaib
authors: Donatella
authors: D
authors: Tampieri
authors: David
authors: D
authors: Williams
authors: Oh Young
authors: OY
authors: Bang
authors: Blaise W
authors: BW
authors: Baxter
authors: Paul A
authors: PA
authors: Burns
authors: Hana
authors: H
authors: Choe
authors: Ji-Hoe
authors: JH
authors: Heo
authors: Christine A
authors: CA
authors: Holmstedt
authors: Brian
authors: B
authors: Jankowitz
authors: Michael
authors: M
authors: Kelly
authors: Guillermo
authors: G
authors: Linares
authors: Jennifer L
authors: JL
authors: Mandzia
authors: Jai
authors: J
authors: Shankar
authors: Sung-Il
authors: SI
authors: Sohn
authors: Richard H
authors: RH
authors: Swartz
authors: Philip A
authors: PA
authors: Barber
authors: Shelagh B
authors: SB
authors: Coutts
authors: Eric E
authors: EE
authors: Smith
authors: William F
authors: WF
authors: Morrish
authors: Alain
authors: A
authors: Weill
authors: Suresh
authors: S
authors: Subramaniam
authors: Alim P
authors: AP
authors: Mitha
authors: John H
authors: JH
authors: Wong
authors: Mark W
authors: MW
authors: Lowerison
authors: Tolulope T
authors: TT
authors: Sajobi
authors: Michael D
authors: MD
authors: Hill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D003131:Combined Modality Therapy; D057510:Endovascular Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D015424:Reperfusion; D016037:Single-Blind Method; D015607:Stents; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D017131:Thrombectomy / Q000295:instrumentation; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator