Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct.

BACKGROUND: The role of endovascular therapy for acute stroke with a large infarction has not been extensively studied in differing populations. METHODS: We conducted a multicenter, prospective, open-label, randomized trial in China involving patients with acute large-vessel occlusion in the anterior circulation and an Alberta Stroke Program Early Computed Tomography Score of 3 to 5 (range, 0 to 10, with lower values indicating larger infarction) or an infarct-core volume of 70 to 100 ml. Patients were randomly assigned in a 1:1 ratio within 24 hours from the time they were last known to be well to undergo endovascular therapy and receive medical management or to receive medical management alone. The primary outcome was the score on the modified Rankin scale at 90 days (scores range from 0 to 6, with higher scores indicating greater disability), and the primary objective was to determine whether a shift in the distribution of the scores on the modified Rankin scale at 90 days had occurred between the two groups. Secondary outcomes included scores of 0 to 2 and 0 to 3 on the modified Rankin scale. The primary safety outcome was symptomatic intracranial hemorrhage within 48 hours after randomization. RESULTS: A total of 456 patients were enrolled; 231 were assigned to the endovascular-therapy group and 225 to the medical-management group. Approximately 28% of the patients in both groups received intravenous thrombolysis. The trial was stopped early owing to the efficacy of endovascular therapy after the second interim analysis. At 90 days, a shift in the distribution of scores on the modified Rankin scale toward better outcomes was observed in favor of endovascular therapy over medical management alone (generalized odds ratio, 1.37; 95% confidence interval, 1.11 to 1.69; P = 0.004). Symptomatic intracranial hemorrhage occurred in 14 of 230 patients (6.1%) in the endovascular-therapy group and in 6 of 225 patients (2.7%) in the medical-management group; any intracranial hemorrhage occurred in 113 (49.1%) and 39 (17.3%), respectively. Results for the secondary outcomes generally supported those of the primary analysis. CONCLUSIONS: In a trial conducted in China, patients with large cerebral infarctions had better outcomes with endovascular therapy administered within 24 hours than with medical management alone but had more intracranial hemorrhages. (Funded by Covidien Healthcare International Trading [Shanghai] and others; ANGEL-ASPECT ClinicalTrials.gov number, NCT04551664.).

The Measures and Achievement of Community Epidemic Prevention against COVID-19 in Taiwan

COVID-19 is an emerging infectious disease occurred in Wuhan, China at the end of 2019. The epidemic began to spread in early 2020 and had become a global pandemic. In order to prevent the disease from entering the community and causing continuous transmission, Taiwan had successfully curbed the spread of COVID-19 through rigid community defense lines. Relevant measures included strengthening the notification of suspected cases, launching an expanded community surveillance program, detecting submerged cases effectively, and following by prompt isolation and adequate treatment, monitoring cases progression throughout the whole medical process. Furthermore, to implement home isolation and home quarantine policy, the Central Epidemic Command Center (CECC) established appropriate tracking and following up systems on persons at risk of infection with smart technology and inter-ministerial cooperation. In addition, the CECC published epidemic prevention guidelines and provided advices for crowded places or activities to strengthen epidemic prevention at those with high risks of infection. Moreover, through multiple channels and platforms, the CECC established communication with the public regarding risks of infection and raised the public’s awareness of epidemic prevention among our people. Thanks to the collective efforts of the public and strict border controls, the epidemic was under stable situation. The CECC substantially lifted the restrictions since June 7, so that the public and industries could return to normalcy. Lastly, to be prepared for the future border controls adjustments, personal health behaviors must be cultivated and rooted deeply in our daily lives. In addition to closely monitoring the epidemic situations and trends, The CECC continues to encourage our people to implement the ＂Epidemic New Life Movement＂ and timely adjust the epidemic prevention strategies according to the epidemic status of COVID-19. Most importantly, the CECC will make every efforts to reduce the risks of community transmission and protect the health of our people.