Endovascular Therapy in Ischemic Stroke With Acute Large‐Vessel Occlusion: Recovery by Endovascular Salvage for Cerebral Ultra‐Acute Embolism Japan Registry 2

Abstract

BackgroundEndovascular therapy has been shown to be effective in patients with acute cerebral large‐vessel occlusion, but real‐world efficacies are unknown.Methods and ResultsWe conducted a prospective registry at 46 centers between October 2014 and January 2017. Eligible patients were those who were aged 20 years or older, with acute cerebral large‐vessel occlusion, and who were hospitalized within 24 hours of the onset. We enrolled both consecutive patients who were treated with or without endovascular therapy. Endovascular therapy included thrombectomy, balloon angioplasty, stenting, local fibrinolysis, and piercing. The primary outcome was a favorable outcome as defined by a modified Rankin Scale of 0 to 2 at 90 days after onset. Secondary outcomes were modified Rankin Scale of 0 to 1 and mortality. Safety outcomes were intracerebral hemorrhage or a recurrence of ischemic stroke. We constructed the 2242 (1121 each) propensity score–matched patients cohort based on a propensity score for endovascular therapy and estimated the adjusted odds ratio, followed by sensitivity analyses on original 2399 (1278 in endovascular therapy versus 1121 in no endovascular therapy) patients. In the propensity score–matched cohort, favorable outcomes were observed in 35.3% and 30.7% of patients in the endovascular therapy and no endovascular therapy groups, respectively (P=0.02). The adjusted odds ratio for the favorable outcome was 1.44 (95% confidence interval, 1.10–1.86, P=0.007). The efficacy of endovascular therapy in achieving favorable outcomes did not differ between our subgroups and in the sensitivity analyses.ConclusionsEndovascular therapy decreased disabilities at 90 days in real‐world patients with acute cerebral large‐vessel occlusion.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT02419794.

Incidence and Prognostic Impact of Intracranial Hemorrhage after Endovascular Treatment for Acute Large Vessel Occlusion

“…We constructed a multivariable logistic model to explore the variables associated with ICH within 24 h after EVT. We included the following potential factors in the model: age ≥75 years, P2R < 35 min, TICI 2b or 3, ASPECTS or pc-ASPECTS 6, presence of smoking, hypertension, diabetes mellitus, hypercholesterolemia, history of ischemic stroke, use of statins and antithrombotic drugs before admission, use of intravenous rt-PA, perioperative edaravone administration, stent retriever, NIHSS score ≥16 [8], occluded anterior circulation, cardioembolic stroke classification, and blood glucose and creatinine levels ≥128 and ≥1.0 mg/dL, respectively. The thresholds for blood glucose and creatinine were determined by the median and reference value, respectively.…”

“…The data that support the findings of this study are available from the corresponding author on reasonable request and with approval from the RES-CUE-Japan Registry 2 investigators. RESCUE-Japan Registry 2 was the prospective multicenter registry, which enrolled 2,420 consecutive patients with acute ischemic stroke with LVO between October 2014 and September 2016 from 46 centers across Japan [8]. Eligible participants were older than 20 years and hospitalized within 24 h after the onset of stroke.…”

Outcomes of Endovascular Therapy versus Microsurgical Treatment for Aneurysmal Subarachnoid Hemorrhage in Patients ≥70 Years of Age

“…After propensity score generation, cohort and treatment groups underwent 1:1 nearest-neighbor matching with a caliper width of 0.25 of the standard deviation of the propensity score. [5][6][7] Matching was performed without replacement treatment, and control units not meeting the matching criteria were excluded. We used the standardized difference to measure the covariate balance.…”

Trends in Endovascular Reperfusion Therapy for Acute Stroke after Introduction of Mechanical Thrombectomy Devices: Japanese Registry of NeuroEndovascular Therapy (JR-NET)3

“…In the "stent retriever" era, Ota et al 22) showed that the median onset-to-door time was 111 min, median door-to-puncture time was 80 min, and median onset-to-puncture time was 201 min in the Tama-Registry of Acute Endovascular Thrombectomy (TREAT), a Japanese regionwide survey regarding EVT for acute stroke conducted from 2015 to 2017. Similarly, Yoshimura et al 23) showed that the median onset-to-door time was 120 min and median onset-to-puncture time was 200 min in a large prospective cohort study of acute stroke patients with large vessel occlusion, the Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism (RESCUE) Japan Registry 2, conducted from 2014 to 2017. According to these studies, which indicated no apparent shortening of the onset-to-door time between the "Merci" and the "stent-retriever" eras, shortening of the door-topuncture time could contribute to faster initiation of EVT.…”