Single-center experience of stent retriever thrombectomy in acute ischemic stroke

Wiącek, Marcin; Kaczorowski, Rafał; Homa, Jarosław; E, Filip; Darocha, Janusz; Dudek, Daniel; Guz, Wiesław; Bartosik-Psujek, Halina

doi:10.1016/j.pjnns.2016.09.001

Cited by 12 publications

(8 citation statements)

References 25 publications

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“…A similarly high proportion of non-ASA/AHA-patients was included in the TREVO Stent-Retriever Acute Stroke (TRACK) registry further supporting the hypothesis that in real life only a small group of patients matches the ASA/AHA guidelines [18]. Similar results were provided in another recently published single center analysis [19].…”

Section: Discussionsupporting

confidence: 70%

Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study

et al. 2020

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Background: Randomized controlled trials (RCTs) demonstrated efficacy and safety of endovascular treatment (ET) in anterior circulation large vessel occlusions (LVO). We aimed at investigating how stroke patients treated by thrombectomy in clinical practice and their outcome compare to cohorts and results of thrombectomy trials. Methods: In a prospective study, we consecutively included stroke patients treated by thrombectomy (2015-2017). Baseline characteristics, procedural and outcome data were analyzed. Outcome was assessed by modified Rankin Scale (mRS) at 90 days. Ordinal regression analysis was performed to identify predictors of outcome. Results: Thrombectomy was applied in 264 patients (median 75 years, 49.6% female). Median baseline National Institutes of Health Stroke Scale (NIHSS) was 16, 58.0% received concomitant intravenous thrombolysis, 62.1% were referred from external hospitals. Median Alberta Stroke Program Early CT Score (ASPECTS) was 7. Successful recanalization (modified Thrombolysis in Cerebral Infarction Score, mTICI 2b/3) was achieved in 72.0%. Symptomatic intracranial hemorrhage (sICH) occurred in 4.5%. Independent outcome (mRS 0-2) was achieved in 26.2%, poor outcome (mRS 5-6) in 49.2%. Only 33.5% met the stringent enrolment criteria of previous RCTs. Lower age, baseline NIHSS, pre-stroke mRS, higher ASPECTS, and successful recanalization were independent predictors of favourable outcome. Conclusions: The majority of stroke patients treated by ET in clinical practice would not have qualified for randomization in prior RCTs. Outcome in real-life patient cohorts is worse than in the highly selected cohorts from randomized trials, while rates of successful recanalization, sICH and outcome predictors are the same. Our findings support ET in broader patient populations than in the RCTs and may improve treatment decision in individual stroke patients with LVO in clinical practice.

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Section: Discussionsupporting

confidence: 70%

Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study

et al. 2020

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“…The age reported in this series (65.1 + 14.6 years) was closer to that reported in Chinese patients (63.3 + 13.7 years old) 17 than in the US patients (69.8 + 13.3 years old), 18 although the population in this last series was 79% Hispanic. Severity scores were also comparable between this and other series; with a median NIHSS score of 16, all our patients experienced moderate to severe stroke with results that were the same as those reported in a Pollack series 19 and 2 and 3 points below those reported in the SWIFT 20 and TREVO 2 21 trials, respectively. Additionally, in our series, the MCA was most common location of vascular occlusion (57.2%), whereas the comparable rate was 66% and 60% in the SWIFT 20 and TREVO 2 21 trials, respectively.…”

Section: Discussionsupporting

confidence: 88%

Endovascular Treatment of Ischemic Stroke in a Developing Country

Márquez-Romero

Góngora‐Rivera

Hernández-Curiel

et al. 2020

Vasc Endovascular Surg

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Background: There is inequality in access to recent advancements in endovascular treatment of acute ischemic stroke (AIS), and Mexico is unusually sensitive to such inequality. Aims: To report the initial experience of the Mexican Endovascular Reperfusion Registry (MERR). Methods: The MERR is an academic, independent, prospective, multicenter, observational registry of patients treated with endovascular reperfusion techniques in Mexican hospitals. The registry includes information on demographic and clinical characteristics, diagnostic procedures, treatments, selected time metrics, and outcomes. Results: In all, 49 (57.1% female) patients from 8 centers were included and had the following characteristics: median National Institute of Health Stroke Scale score, 16; median Alberta Stroke Program Early CT Score score, 9; received intravenous tissue-type plasminogen activator, 49%; and treated with mechanical devices, 39 (79.6%), including 20 treated with stent retriever alone, 2 with retriever and intra-arterial thrombolysis (IAt), 10 with catheter aspiration (4 in combination with IAt), 6 with a combination of catheter aspiration and stent retriever, and 1 with IAt followed by balloon angioplasty. Recanalization (TICI 2b or better) was achieved in 69.4% of the patients. The median clot to recanalization time was 30 minutes. A modified Rankin scale ≤2 was achieved in 44.9% of the patients, and 68.2% of these were treated with stent retriever ( P = .011). Procedure-related morbidity was 12.2%, 7 patients presented intracerebral hemorrhage (71.4% asymptomatic), and all-cause mortality was 6.1%. Conclusions: Endovascular treatment of AIS in Mexico is feasible and has an efficacy comparable to that of other countries. Still, many challenges remain, especially pertaining to high costs and difficulties in equality in access to treatment.

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“…According to the German Stroke Registry [4] 28.5% patients died and 36.7% had good functional outcomes after ET in the carotid artery system after 90 days, which is close to our data. The outcomes differ from the results of randomized trials in other publications as well [5] and in a senior age group in particular [6]. When comparing ET outcomes in the vertebrobasilar system with those provided in the German registry [3], there are substantial differences: 30.9% patients died after 90 days (in this study this figure was 52.9% at discharge) and 37.7% had good functional outcomes (in this study 24.3% at discharge).…”

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confidence: 78%

How to Set up a Thrombectomy Service

et al. 2020

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Single-center experience of stent retriever thrombectomy in acute ischemic stroke

Abstract: Stent retriever thrombectomy for the treatment of ischemic stroke is safe, provides high rate of recanalization and good clinical outcomes in the setting of large vessel occlusion.

Cited by 12 publications

References 25 publications

Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study

Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study

Endovascular Treatment of Ischemic Stroke in a Developing Country

How to Set up a Thrombectomy Service

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