Thrombectomy for Stroke in the Public Health Care System of Brazil

The New England Journal of Medicine
Sheila O MartinsRESILIENT Investigators

Abstract

Randomized trials involving patients with stroke have established that outcomes are improved with the use of thrombectomy for large-vessel occlusion. These trials were performed in high-resource countries and have had limited effects on medical practice in low- and middle-income countries. We studied the safety and efficacy of thrombectomy in the public health system of Brazil. In 12 public hospitals, patients with a proximal intracranial occlusion in the anterior circulation that could be treated within 8 hours after the onset of stroke symptoms were randomly assigned in a 1:1 ratio to receive standard care plus mechanical thrombectomy (thrombectomy group) or standard care alone (control group). The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. A total of 300 patients were enrolled, including 79 who had undergone thrombectomy during an open-label roll-in period. Approximately 70% in the two groups received intravenous alteplase. The trial was stopped early because of efficacy when 221 of a planned 690 patients had undergone randomization (111 to the thrombectomy group and 110 to the control group). The common odds ratio for a better distribution of scores on the mo...Continue Reading

References

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Citations

Sep 3, 2020·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·Rodrigo RiveraRaul G Nogueira
Oct 30, 2020·International Journal of Stroke : Official Journal of the International Stroke Society·Luís H de Castro-AfonsoDaniel G Abud
Dec 8, 2020·Frontiers in Neurology·Jae H ChoiJohn Pile-Spellman
Dec 23, 2020·Stroke; a Journal of Cerebral Circulation·Jean-Marc OlivotUNKNOWN FRAME Investigators*
Jan 13, 2021·Stroke; a Journal of Cerebral Circulation·Raul G NogueiraUNKNOWN Trevo Registry and DAWN Trial Investigators
Jan 21, 2021·Stroke; a Journal of Cerebral Circulation·Joseph P Broderick, Michael D Hill
Feb 17, 2021·Stroke; a Journal of Cerebral Circulation·Ashutosh P Jadhav, Bruce C V Campbell
Feb 9, 2021·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Muhammad WaqasElad I Levy
Feb 27, 2021·Frontiers in Neurology·Guillaume CharbonnierThierry Moulin
Feb 27, 2021·Frontiers in Neurology·Fernando Gongora-RiveraUNKNOWN Neurological Endovascular Therapy – Mexican Group (NET-MX Group)
Oct 16, 2020·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·Luis A Lemme Plaghos
Jan 19, 2021·International Journal of Stroke : Official Journal of the International Stroke Society·UNKNOWN SVIN COVID-19 global registryThanh Nguyen
Apr 2, 2021·Frontiers in Neurology·Patrick D LydenBerislav V Zlokovic
May 1, 2021·Brain Sciences·Ricardo C NogueiraThompson G Robinson
May 18, 2021·Frontiers in Surgery·Pedro Tadao Hamamoto FilhoRodrigo Bazan
Jun 10, 2021·AJR. American Journal of Roentgenology·Eduardo Portela de OliveiraRichard I Aviv
Jun 15, 2021·The Cochrane Database of Systematic Reviews·Melinda B RoaldsenHaakon Lindekleiv
Jun 19, 2021·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·Vitor Rodrigues FornazariDaniel Giansante Abud
Aug 17, 2021·Topics in Magnetic Resonance Imaging : TMRI·Jayson LavieArindam Rano Chatterjee
Sep 15, 2021·Stroke; a Journal of Cerebral Circulation·Thanh N Nguyen, Daniel Strbian
Sep 30, 2021·Acta neurologica Belgica·Emilia NivelleVincent Thijs
Oct 15, 2021·Stroke; a Journal of Cerebral Circulation·Lucie A van den BergUNKNOWN MR CLEAN Investigators
Oct 19, 2021·Frontiers in Neurology·Sheila Cristina Ouriques MartinsRaul G Nogueira
Nov 4, 2021·International Journal of Stroke : Official Journal of the International Stroke Society·Ana Claudia de SouzaRaul G Nogueira

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