Acute Endovascular Stroke Treatment in Germany in 2019

Abstract

Purpose Since the incidental discovery and systematic introduction of mechanical endovascular stroke treatment in 2015 there are few reports about the real-life situation in daily clinical practice. The aim of this study was to evaluate the mechanical thrombectomy data documented in the quality assurance database of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society of Neuroradiology (DGNR) in 2019. Methods We retrospectively analyzed the clinical and procedural data of all mechanical thrombectomies that were entered into the voluntary nationwide database in 2019. The information of each procedure was provided on a standardized web-based data sheet. Data were exported and analyzed by a group of experts on behalf of the DGNR. Results A total of 13,840 data sets from 158 participating centers could be analyzed. Mean age of the patients was 74 ± 13 years; 53.9% were female. Vessel occlusion was located in the anterior circulation in 87.4%, in the posterior circulation in 10.7%. On hospital admission, the median National Institutes of Health Stroke Scale (NIHSS) was 14 (lower/upper quartile 10/19); at hospital discharge, median NIHSS had dropped to 9 (lower/upper quartile 2/12; p < 0.001). Recanalization of the occluded vessel segment was successful (TICI 2b + 3) in 88.4%. The reported complication rate was 7.3%, with subarachnoid hemorrhage as the most frequent complication (3.4%), followed by parenchymal hemorrhage (1.7%) and embolization in new territories (1.2%). Overall, the median time interval from symptom onset to hospital admission was 94 min (quartiles 59/180 min), the median time from hospital admission to groin puncture was 74 min (lower/upper quartile 47/103 min), and the median duration of the procedure 43 min (lower/upper quartile 25.2/73.2 min). A comparison between primary and secondary referral revealed a significant faster symptom-to-intervention time for primary referrals, whereas in-house workflows showed no significant difference. Conclusion The analysis represents the largest documented cohort of acute stroke patients treated by thrombectomy. The documentation allows for a detailed evaluation of procedural, clinical, logistic and radiation exposure data and might be used for monitoring the quality of the treatment on a nationwide scale.

Mechanical thrombectomy for acute ischemic stroke in COVID-19 patients: multicenter experience in 111 cases

“…Another important factor potentially negatively affecting the clinical outcome of infectious patients treated with MT due to LVO is the significant delay in performing thrombectomy. The median time interval from symptom onset to groin puncture in our study was higher than findings of the German Stroke Registry in 2019 (median 220 min vs 160 min) 27. Additionally, the time interval from onset to groin puncture presented as an independent predictor for an unfavorable outcome in our multivariate analysis.…”

“…The median time interval from symptom onset to groin puncture in our study was higher than findings of the German Stroke Registry in 2019 (median 220 min vs 160 min). 27 Additionally, the time interval from onset to groin puncture presented as an independent predictor for an unfavorable outcome in our multivariate analysis. Multiple studies have shown declines in the volumes of MT, IVT and stroke hospitalizations over the pandemic with delays in hospital arrival times and treatment workflow.…”

Common Data Elements for Meaningful Stroke Documentation in Routine Care and Clinical Research: Retrospective Data Analysis

“…Registries and quality standards: Two data models from the association of German stroke registries (ADSR) are considered, one regarding acute care for stroke patients in hospitals and one regarding thrombectomy and lysis therapy after stroke [ 9 , 22 ]. Moreover, a registry from Austria was included in the analysis [ 18 ].…”

Acute ischemic stroke treatment model for Poland in the mechanical thrombectomy era – which way to go?

“…We realize that there are many patients who have been failed by the present system, but since they are not reported, we cannot see the scale of the need that is unmet [ 39 , 41 , 42 ]. Given the number of mechanical thrombectomy procedures performed in other healthcare systems in the world, we can only estimate that we provide good services to less than half of the eligible patients [ 13 – 17 ]. In 2020, approximately 90,000 patients diagnosed with acute stroke were hospitalized in Poland, with roughly 75,000 identified as ischemic.…”

“…Among those, 33,000 cases were diagnosed to be LVO strokes, of which 11,580 were thrombectomy-eligible (the sum of patients presenting with LVO within 6 h from onset and those presenting later with favorable perfusion criteria), which makes 13% of all ischemic strokes [ 43 ]. Germany with its staggering 150 MT-center-strong network treats 7.2% of ischemic strokes invasively [ 13 ], and the Czech Republic even more (7.5–8.1%) [ 16 ]. France, with almost twice as many MT centers at its disposal (2018) as Poland today, decided to implement considerable changes to improve access to endovascular treatment.…”