title: Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: A randomized care trial.
abstract: Until recently, the benefits of endovascular treatment in stroke were not proven. Care trials have been designed to simultaneously offer yet-to-be validated interventions and verify treatment outcomes. Our aim was to implement a care trial for patients with acute ischemic stroke.
  
  
  
  The study was offered to all patients considered for endovascular management of acute ischemic stroke in one Canadian hospital. Inclusion criteria were broad: onset of symptoms≤5h or at any time in the presence of clinical-imaging mismatch and suspected or demonstrated proximal large vessel occlusion. Exclusion criteria were few: established infarction or hemorrhagic transformation of the target symptomatic territory and poor 3-month prognosis. The primary outcome was mRS≤2 at 3 months. Patients were randomly allocated to standard care or standard care plus endovascular treatment. ClinicalTrials.gov: Identifier NCT02157532.
  
  
  
  Seventy-seven patients were recruited in 19 months (March 2013-October 2014) at a single center. Randomized allocation was interrupted when other trials showed the benefits of endovascular therapy. At 3 months, 20 of 40 patients (50.0%; 95% CI: 35%-65%) in the intervention group had reached the primary outcome, compared to 14 of 37 patients (37.8%; 95% CI: 24%-54%) in the control group (P=0.36). Eleven patients in the intervention group died within 3 months compared to 9 patients in the standard care group.
  
  
  
  A care trial was implemented to offer verifiable care to acute stroke patients. This approach offers a promising means to manage clinical dilemmas and guide uncertain practices.
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of radiology, 1560, Sherbrooke east, Pavilion Simard, suite Z12909, H2L 4M1 Montreal, Quebec, Canada. Electronic address: naim.khoury@umontreal.ca.
authors.forename: Naim N
authors.initials: NN
authors.lastname: Khoury
authors.affiliation: Department of surgery, division of neurosurgery, university of Alberta hospital, Mackenzie health sciences centre, Edmonton, Alberta, Canada (TED). Electronic address: tdarsaut@ualberta.ca.
authors.forename: Tim E
authors.initials: TE
authors.lastname: Darsaut
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of radiology, 1560, Sherbrooke east, Pavilion Simard, suite Z12909, H2L 4M1 Montreal, Quebec, Canada. Electronic address: jimmy.ghostine@gmail.com.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Ghostine
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of medicine, division of neurology, 1560, Sherbrooke east, H2L 4M1 Montreal, Quebec, Canada. Electronic address: yan.deschaintre.chum@ssss.gouv.qc.ca.
authors.forename: Yan
authors.initials: Y
authors.lastname: Deschaintre
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of medicine, division of neurology, 1560, Sherbrooke east, H2L 4M1 Montreal, Quebec, Canada. Electronic address: nicole.daneault.chum@ssss.gouv.qc.ca.
authors.forename: Nicole
authors.initials: N
authors.lastname: Daneault
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of medicine, division of neurology, 1560, Sherbrooke east, H2L 4M1 Montreal, Quebec, Canada. Electronic address: andre.p.durocher.chum@ssss.gouv.qc.ca.
authors.forename: André
authors.initials: A
authors.lastname: Durocher
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of medicine, division of neurology, 1560, Sherbrooke east, H2L 4M1 Montreal, Quebec, Canada. Electronic address: sylanthier@gmail.com.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Lanthier
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of medicine, division of neurology, 1560, Sherbrooke east, H2L 4M1 Montreal, Quebec, Canada. Electronic address: aypoppe@yahoo.ca.
authors.forename: Alexandre Y
authors.initials: AY
authors.lastname: Poppe
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of medicine, division of neurology, 1560, Sherbrooke east, H2L 4M1 Montreal, Quebec, Canada. Electronic address: c_odier@hotmail.com.
authors.forename: Céline
authors.initials: C
authors.lastname: Odier
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of medicine, division of neurology, 1560, Sherbrooke east, H2L 4M1 Montreal, Quebec, Canada. Electronic address: louise-helene.lebrun.chum@ssss.gouv.qc.ca.
authors.forename: Louise-Hélène
authors.initials: LH
authors.lastname: Lebrun
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of radiology, 1560, Sherbrooke east, Pavilion Simard, suite Z12909, H2L 4M1 Montreal, Quebec, Canada. Electronic address: francois.guilbert.chum@ssss.gouv.qc.ca.
authors.forename: François
authors.initials: F
authors.lastname: Guilbert
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of radiology, 1560, Sherbrooke east, Pavilion Simard, suite Z12909, H2L 4M1 Montreal, Quebec, Canada; Groupe d'étude de la thrombose en Bretagne Occidentale (GETBO, EA 3878), 29609 Brest cedex, France. Electronic address: jcgentric@gmail.com.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Gentric
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of radiology, 1560, Sherbrooke east, Pavilion Simard, suite Z12909, H2L 4M1 Montreal, Quebec, Canada. Electronic address: batista.nchir@gmail.com.
authors.forename: André
authors.initials: A
authors.lastname: Batista
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of radiology, 1560, Sherbrooke east, Pavilion Simard, suite Z12909, H2L 4M1 Montreal, Quebec, Canada. Electronic address: alain.weill.chum@ssss.gouv.qc.ca.
authors.forename: Alain
authors.initials: A
authors.lastname: Weill
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of radiology, 1560, Sherbrooke east, Pavilion Simard, suite Z12909, H2L 4M1 Montreal, Quebec, Canada. Electronic address: daniel.roy.chum@ssss.gouv.qc.ca.
authors.forename: Daniel
authors.initials: D
authors.lastname: Roy
authors.affiliation: Service de neuroradiologie diagnostique et thérapeutique, hôpital Central, CHU de Nancy, 54000 Nancy, France. Electronic address: s.bracard@gmail.com.
authors.forename: Serge
authors.initials: S
authors.lastname: Bracard
authors.affiliation: Centre hospitalier universitaire de Montréal, Notre-Dame hospital, department of radiology, 1560, Sherbrooke east, Pavilion Simard, suite Z12909, H2L 4M1 Montreal, Quebec, Canada. Electronic address: jean.raymond@umontreal.ca.
authors.forename: Jean
authors.initials: J
authors.lastname: Raymond
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Acute stroke; Endovascular treatment; Randomized clinical trial; Thrombectomy