Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial.

Abstract

RATIONALE:

Mechanical thrombectomy (MT) associated with the best medical treatment (BMT) has recently shown efficacy for the management of acute ischemic stroke (AIS) secondary to a large vessel occlusion. However, evidence is lacking regarding the benefit of MT for more distal occlusions.

AIM:

To evaluate the efficacy in terms of good clinical outcome at 3 months of MT associated with the BMT over the BMT alone in AIS related to a distal occlusion.

METHODS:

The DISCOUNT trial is a multicenter open-label randomized controlled trial involving French University hospitals. Adult patients (⩾18 years) with an AIS involving the anterior or posterior circulation secondary to a distal vessel occlusion within 6 h of symptom onset or within 24 h if no hyperintense signal on fluid attenuation inversion recovery acquisition will be randomized 1:1 to receive either MT associated with the BMT (experimental group) or BMT alone (control group). The number of patients to be included is 488.

STUDY OUTCOMES:

The primary outcome is the rate of good clinical outcome at 3 months defined as a modified Rankin scale (mRS) ⩽2 and evaluated by an independent assessor blinded to the intervention arm. Secondary outcomes include recanalization of the occluded vessel within 48 h, angiographic reperfusion in the experimental group, 3-month excellent clinical outcome (mRS ⩽ 1), all adverse events, and death. A cost utility analysis will estimate the incremental cost per quality-adjusted life year (QALY) gained.

DISCUSSION:

If positive, this study will open new insights in the management of AISs.

TRIAL REGISTRATION:

ClinicalTrials.gov: NCT05030142 registered on 1 September 2021.

• Authors: Frédéric Clarençon, Isabelle Durand-Zaleski, Kévin Premat, Amandine Baptiste, Emmanuel Chabert, Anna Ferrier, Marc-Antoine Labeyrie, Peggy Reiner, Laurent Spelle, Christian Denier, Titien Tuilier, Hassan Hosseini, Christine Rodriguez-Régent, Guillaume Turc, Cédric Fauché, Matthias Lamy, Bertrand Lapergue, Arturo Consoli, Charlotte Barbier, Marion Boulanger, Nicolas Bricout, Hilde Henon, Benjamin Gory, Sébastien Richard, Aymeric Rouchaud, Francisco Macian-Montoro, Omer Eker, Tae-Hee Cho, Sébastien Soize, Solène Moulin, Jean-Christophe Gentric, Serge Timsit, Jean Darcourt, Jean-François Albucher, Kévin Janot, Mariam Annan, Fernando Pico, Vincent Costalat, Caroline Arquizan, Gautier Marnat, Igor Sibon, Raoul Pop, Valérie Wolff, Eimad Shotar, Stéphanie Lenck, Nader-Antoine Sourour, Anne Radenne, Sonia Alamowitch, Agnès Dechartres
• Journal: International journal of stroke : official journal of the International Stroke Society (Int J Stroke) Pg. 17474930231205213 (Oct 12 2023) ISSN: 1747-4949 [Electronic] United States
• PMID: 37740419 (Publication Type: Journal Article)