Safety and efficacy of thrombectomy in acute ischaemic stroke (REVASCAT): 1-year follow-up of a randomised open-label trial

Aja, Lucía; Lara, Blanca; Martí‐Fàbregas, Joan; Cerdá, Neus; Ribó, Marc; Sanjuan, Estela; Rubiera, Marta; Pagola, Jorge; Flores, Alan; Muchada, Marián; Meler, Pilar; Huerga, Elena Charro; Gelabert, S.; Coscojuela, Pilar; Tomasello, Alejandro; Rodríguez, Daniel; Santamarina, Esteban; Maisterra, Olga; Boned, Sandra; Seró, Laia; Rovira, Àlex; Molina, Carlos A.; Millán, Mònica; Muñoz, Lucía Campos; Ossa, Natàlia Pérez de la; Gomis, Meritxell; Dorado, Laura; López‐Cancio, Elena; Palomeras, Ernest; Munuera, Josep; Bermejo, Pablo García; Remollo, Sebastià; Castaño, Carlos; García-Sort, R.; Cuadras, Patricia; Puyalto, Paloma; Hernández‐Pérez, María; Jiménez, Marta; Martínez-Piñeiro, Alicia; Lucente, Giuseppe; Dávalos, Antoni; Chamorro, Ángel; Urra, Xabier; Obach, Vı́ctor; Cervera, Álvaro; Amaro, Sergio; Llull, Laura; Codas, Javier; Balasa, Mircea; Navarro, J.; Ariño, Helena; Aceituno, Anna; Rudilosso, Salvatore; Renú, Arturo; Macho, Juan; Román, Luís San; Blasco, Jordi; López, Antonio; Macías, Napoleón; Cardona, Pere; Quesada, Helena; Rubio, Francisco; Cano, Luis; Miquel, María Ángeles de; Jovin, Tudor G; Serena, Joaquı́n; Cobo, Erik; Albers, Gregory W.; Lees, KR; Arenillas, Juan F.; Roberts, R.; Goyal, Mayank; Demchuk, Andrew M.; Minhas, Priyanka; Al-Ajlan, Fahad S.; Salluzzi, Marina; Zimmel, L; Patel, Smit; Eesa, Muneer; Kummer, Rüdiger von; Jankowitz, Brian T.; Plana, Mercè Salvat

doi:10.1016/s1474-4422(17)30047-9

Cited by 88 publications

(62 citation statements)

References 27 publications

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“…These current results suggested that successful reperfu- Although previous prospective studies have demonstrated the beneficial effects of endovascular therapy on long-term outcome [8,9], the association was not independent of the 90-days mRS scores in the REVASCAT study [8]. The different results from our current study could be attributed to the difference of a study design.…”

Section: Discussioncontrasting

confidence: 85%

“…While our current study compared the successful reperfusion group and the unsuccessful reperfusion group, the REVASCAT study compared the thrombectomy group and the control group. In the thrombectomy group of the REVASCAT study, the rates of successful reperfusion, defined as mTICI score ≥2b, evaluated by a core lab and local investigators were 65.7 and 79.6% respectively [8].…”

Section: Discussionmentioning

confidence: 99%

“…In a 1-year follow-up study of the Randomized Trial of Revascularization with Solitaire FR Device versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting within Eight Hours of Symptom Onset (REVASCAT) trial, outcomes at both 5 days and 90 days were strongly associated with the 12-month outcomes [8]. In a 2-year follow-up study of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial, although the treatment effects on outcomes at 90 days and 2 years were similar, the Kaplan-Meier curves demonstrated that the difference of mortality rate between the endovascular therapy group and standard therapy group kept widening from 3 months to 2 years [9].…”

Section: Introductionmentioning

confidence: 99%

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Successful Reperfusion with Endovascular Therapy Has Beneficial Effects on Long-Term Outcome Beyond 90 Days

et al. 2019

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Background and Purpose: Recent studies have demonstrated that endovascular reperfusion therapy improves clinical outcomes at 90 days after ischemic stroke. However, the effects on long-term outcomes are not well known. We hypothesized that successful reperfusion might be associated with long-term improvement beyond 90 days after endovascular therapy. To assess the long-term effects beyond 90 days, we analyzed the association of successful reperfusion with a temporal change in modified Rankin Scale (mRS) score from 90 days to 1 year after endovascular therapy. Methods: We retrospectively analyzed a database of consecutive patients with acute ischemic stroke who received endovascular therapy between April 2006 and March 2016 at 4 centers. We compared the incidences of improvement and deterioration in patients with successful reperfusion (i.e., modified thrombolysis in cerebral infarction score of 2b or 3) with those in patients with unsuccessful reperfusion. We defined improvement and deterioration as decrease and increase on the mRS score by 1 point or more from 90 days to 1 year after endovascular therapy respectively. Results: A total of 268 patients were included in the current study. The rate of patients with improvement tended to be higher in patients with successful reperfusion than in patients with unsuccessful reperfusion (20% [34/167 patients] vs. 12% [12/101], p = 0.07). The rate of patients with deterioration was lower in patients with successful reperfusion than in patients with unsuccessful reperfusion (25% [42/167] vs. 42% [42/101], p < 0.01). After adjustment for confounders, successful reperfusion was associated with improvement (adjusted OR 2.65; 95% CI 1.23–5.73; p < 0.05) and deterioration (adjusted OR 0.33; 95% CI 0.18–0.62; p < 0.01), independent of the 90-day mRS score. Conclusions: Successful reperfusion has further beneficial legacy effects on long-term outcomes beyond 90 days after stroke.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Successful Reperfusion with Endovascular Therapy Has Beneficial Effects on Long-Term Outcome Beyond 90 Days

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“…18 If a recurrence occurred, patients entered the acute phase again. In this case, transitions to health states were restricted to mRS scores equal to or greater than the previous mRS score.…”

Section: Model Structurementioning

confidence: 99%

Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain

Andrés-Nogales

Álvarez

Miquel

et al. 2017

European Stroke Journal

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Introduction: To assess the cost-effectiveness of stent-retriever mechanical thrombectomy and intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in patients with acute ischaemic stroke due to large vessel occlusions in Spain. Materials and methods: Clinical data were taken from the SWIFT PRIME clinical trial. A lifetime Markov state transition model defined by the modified Rankin Scale score was developed to estimate costs and health outcomes (life years gained and quality adjusted life years). A Spanish National Health System perspective (direct medical costs) was considered. Resource utilisation and utilities were obtained from available published data and endorsed by an expert panel. Costs (E, 2016) were obtained from various Spanish sources. Deterministic and probabilistic sensitivity analyses were performed. Results: Stent-retriever thrombectomy after intravenous tissue plasminogen activator was associated with better outcomes (1.17 life years gained and 2.51 quality adjusted life years) and savings of E44,378, resulting in a dominant therapy over intravenous tissue plasminogen activator alone. A net monetary benefit of E119,744 was obtained considering a willingness-to-pay threshold of E30,000/quality adjusted life year gained. The combined therapy was also dominant in all sensitivity analyses, deterministic and probabilistic. Discussion: The results were consistent with a previously published cost-effectiveness analysis and reinforce the likeliness of the selection of stent-retriever mechanical thrombectomy plus intravenous tissue plasminogen activator over intravenous tissue plasminogen activator alone. Conclusion: Stent-retriever thrombectomy after intravenous tissue plasminogen activator is a dominant alternative over intravenous tissue plasminogen activator alone (more effective and less costly) for the treatment of acute ischaemic stroke patients with large vessel occlusions in the Spanish setting.

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“…Discharge mRS may not accurately predict the 90 day mRS but it is most likely correct in 80% of cases 16. Additionally, it is important to highlight that the purpose of this paper was not to assess clinical outcome, as prior trials have already demonstrated better clinical outcomes with faster door to puncture times 13…”

Section: Discussionmentioning

confidence: 99%

Referral facility CT perfusion prior to inter-facility transfer in patients undergoing mechanical thrombectomy

Aghaebrahim

Sauvageau

Aguilar‐Salinas

et al. 2017

J NeuroIntervent Surg

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Safety and efficacy of thrombectomy in acute ischaemic stroke (REVASCAT): 1-year follow-up of a randomised open-label trial

Cited by 88 publications

References 27 publications

Successful Reperfusion with Endovascular Therapy Has Beneficial Effects on Long-Term Outcome Beyond 90 Days

Successful Reperfusion with Endovascular Therapy Has Beneficial Effects on Long-Term Outcome Beyond 90 Days

Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain

Referral facility CT perfusion prior to inter-facility transfer in patients undergoing mechanical thrombectomy

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