03252nam a2200337   4500001000800000005001700008007000300025008004100028040000800069041000800077100001900085245006200104300002500166520218300191650002202374650003002396650003202426650001802458650005602476650004102532650003302573700002802606700002702634700002302661700002302684700002702707700002202734773011002756942003102866999001702897ESSALUD20260902155800.0ta      t        pe ||||| |||| 00| 0 spa d  aBMG  aeng  aHu, Wei954457  aEndovascular Treatment of Medium-Vessel-Occlusion Strokes  apáginas: 1894-1904  aBackground: Endovascular thrombectomy for acute ischemic stroke due to medium-vessel occlusion has had varying results across trials. Whether thrombectomy improves functional outcomes in patients with medium-vessel occlusion and moderate-to-severe deficits is unclear. Methods: We conducted an open-label, randomized trial with blinded outcome assessment at 48 centers in China. Eligible patients were adults who presented within 24 hours after the onset of a moderate-to-severe stroke (National Institutes of Health Stroke Scale [NIHSS] score, ≥6; scale, 0 to 42, with higher scores indicating greater neurologic deficits) due to occlusion of a medium vessel. Patients were assigned in a 1:1 ratio to thrombectomy plus medical management (thrombectomy group) or medical management alone (control group). The primary outcome was functional disability as measured by the shift in the modified Rankin scale score (scale, 0 [no disability] to 6 [death]) at 90 days. Violation of the proportional-odds assumption precluded the use of shift in the modified Rankin scale score, so as prespecified, functional independence (modified Rankin scale score of 0, 1, or 2) at 90 days was used as the primary outcome. Safety outcomes were symptomatic intracranial hemorrhage and 90-day mortality. Results: Among 280 patients in the thrombectomy group and 283 in the control group, the median age was 71 years, the median NIHSS score was 10 (range, 3 to 36), and 42.8% were women; 36.6% received intravenous thrombolysis. Functional independence at 90 days was seen in 58.6% of the patients in the thrombectomy group and in 46.6% of those in the control group (adjusted rate ratio, 1.24; 95% confidence interval, 1.07 to 1.44; P=0.004). The incidence of symptomatic intracranial hemorrhage was 4.7% in the thrombectomy group and 2.2% in the control group; 90-day mortality was 11.1% and 10.2%, respectively. Conclusions: Among patients with acute ischemic stroke due to medium-vessel occlusion and moderate-to-severe deficits, thrombectomy led to a greater likelihood of functional independence than medical management alone but also to a higher risk of symptomatic intracranial hemorrhage.   aGERIATRÍA91852  aCUIDADOS INTENSIVOS95208  aRADIOLOGÍA GENERAL954381  aICTUS 954458  aENFERMEDAD ARTERIAL PERIFÉRICA Y AÓRTICA954459  aMEDICINA DE URGENCIAS GENERAL954078  aCARDIOLOGÍA GENERAL953638  aJing, Xiaozhong 954460  aChen, Zhongjun 954461  aZheng, Jin 954462  aYi, Tingyu 954463  aZheng, Tuanyuan954464  aLi, Zhide 9544650 022717922669dMassachusetts NEJM GroupoNEJM014tThe New England Journal of Medicine wESSALUDx0028-4793  cARTICULOSe2026-08-31zsqb  c22900d22900