000			03246nam a2200337 4500
001			ESSALUD
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040			_aBMG
041			_aeng
100			_aHu, Wei _954457
245			_aEndovascular Treatment of Medium-Vessel-Occlusion Strokes
300			_apáginas: 1894-1904
520			_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.
650			_aGERIATRÍA _91852
650			_aCUIDADOS INTENSIVOS _95208
650			_aRADIOLOGÍA GENERAL _954381
650			_aICTUS _954458
650			_aENFERMEDAD ARTERIAL PERIFÉRICA Y AÓRTICA _954459
650			_aMEDICINA DE URGENCIAS GENERAL _954078
650			_aCARDIOLOGÍA GENERAL _953638
700			_aJing, Xiaozhong _954460
700			_aChen, Zhongjun _954461
700			_aZheng, Jin _954462
700			_aYi, Tingyu _954463
700			_aZheng, Tuanyuan _954464
700			_aLi, Zhide _954465
773	0		_022717 _922669 _dMassachusetts NEJM Group _oNEJM014 _tThe New England Journal of Medicine _wESSALUD _x0028-4793
942			_cARTICULOS _e2026-08-31 _zsqb
999			_c22900 _d22900