Endovascular Treatment of Medium-Vessel-Occlusion Strokes.

Whether thrombectomy improves functional outcomes in patients with medium-vessel occlusion and moderate-to-severe deficits is unclear.

对于中等血管闭塞和中度至重度缺陷的患者，血栓切除术是否能改善功能结果尚不明确。

Methods

We conducted an open-label, randomized trial with blinded outcome assessment at 48 centers in China.

我们在中国的48个中心开展了一项开放标签、随机试验，并对结果进行了盲法评估。

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.

符合条件的患者为成年患者，在中度至重度中风（美国国立卫生研究院卒中量表[NIHSS]评分≥6；评分范围0至42，分数越高表示神经功能缺损越严重）发作后24小时内就诊，且由于中等大小血管阻塞所致。

Patients were assigned in a 1:1 ratio to thrombectomy plus medical management (thrombectomy group) or medical management alone (control group).

患者以1:1的比例被分配到血栓切除术加药物治疗（血栓切除组）或仅接受药物治疗（对照组）。

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.

主要结果是通过90天时改良Rankin量表评分（评分范围，0[无残疾]至6[死亡]）的变化来衡量的功能残疾。

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.

违反比例风险假设，使得无法使用改良Rankin量表评分的转移，因此，如预先规定的那样，90天时的功能独立（改良Rankin量表评分为0、1或2）被用作主要结果。

Safety outcomes were symptomatic intracranial hemorrhage and 90-day mortality.

安全性结果为症状性颅内出血和90天的死亡率。

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.

在280名接受血栓切除术的患者和283名对照组患者中，中位年龄为71岁，中位NIHSS评分为10（范围，3至36），女性占42.8%；36.6%的患者接受了静脉溶栓治疗。

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).

在90天时，血栓切除组58.6%的患者和对照组46.6%的患者实现了功能独立（调整后的率比为1.24；95%置信区间为1.07至1.44；P = 0.004）。

The incidenceof 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.

在血栓切除组中，症状性颅内出血的发生率为4.7%，对照组为2.2%；90天的死亡率分别为11.1%和10.2%。

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.

对于因中等血管闭塞和中度至重度缺损导致的急性缺血性中风患者，血栓切除术比单独的药物管理更有可能实现功能独立，但也带来了更高的症状性颅内出血风险。

(Funded by the National Natural Science Foundation of China and the Noncommunicable Chronic Diseases-National Science and Technology Major Project; ORIENTAL-MeVO ClinicalTrials.gov number, NCT06146790.).

(本研究由国家自然科学基金和国家重大慢性非传染性疾病科技重大专项资助；ORIENTAL-MeVO临床试验注册号为NCT06146790。)