The Italian Registry of Endovascular Treatment in Acute Stroke: rationale, design and baseline features of patients

Abstract

Endovascular treatment (ET) showed to be safe in acute stroke, but its superiority over intravenous thrombolysis is debated. As ET is rapidly evolving, it is not clear which role it may deserve in the future of stoke treatments. Based on an observational design, a treatment registry allows to study a broad range of patients, turning into a powerful tool for patients' selection. We report the methodology and a descriptive analysis of patients from a national registry of ET for stroke. The Italian Registry of Endovascular Treatment in Acute Stroke is a multicenter, observational registry running in Italy from 2010. All patients treated with ET in the participating centers were consecutively recorded. Safety measures were symptomatic intracranial hemorrhage, procedural adverse events and death rate. Efficacy measures were arterial recanalization and 3-month good functional outcome. From 2008 to 2012, 960 patients were treated in 25 centers. Median age was 67 years, male gender 57 %. Median baseline NIHSS was 17. The most frequent occlusion site was Middle cerebral artery (46.9 %). Intra-arterial thrombolytics were used in 165 (17.9 %) patients, in 531 (57.5 %) thrombectomy was employed, and 228 (24.7 %) patients received both treatments. Baseline features of this cohort are in line with data from large clinical series and recent trials. This registry allows to collect data from a real practice scenario and to highlight time trends in treatment modalities. It can address unsolved safety and efficacy issues on ET of stroke, providing a useful tool for the planning of new trials.

Stroke care in Italy: An overview of strategies to manage acute stroke in COVID-19 time

“…13 The monitoring of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) treatments takes place respectively through the SITS-ISTR register and the REI (Italian Endovascular Registry). 14…”

“…13 The monitoring of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) treatments takes place respectively through the SITS-ISTR register and the REI (Italian Endovascular Registry). 14 Over the years, the management path of acute stroke in Italy has reached a level of organisation, capillary diffusion and efficiency that, in most regions, the number of IVT is greater than 10% of hospitalisations for acute ischemic stroke. In 2018, 12,469 IVT and 4343 EVT were performed, with a relative increase of 18.8% and 65.2%, respectively, compared to the treatments carried out in 2017, against a very modest increase in the number of treating centres.…”

Combined intravenous and endovascular treatment versus primary mechanical thrombectomy. The Italian Registry of Endovascular Treatment in Acute Stroke

“…We retrieved data from The Italian Registry of Endovascular Stroke Treatments, 28 a multicenter, prospective, observational internet-based registry (http:// www.registroendovascolare.it). The purposes, organization, and structure of the Registry were described in more details elsewhere.…”

“…The purposes, organization, and structure of the Registry were described in more details elsewhere. 28 All patients who underwent endovascular treatment in the participating centers were consecutively recorded: for each patient, demographics, stroke risk factors, personal history, stroke severity, laboratory findings, any contraindication for IVT (and the reasons for exclusion from IVT), time from symptom onset to diagnosis and treatment, baseline neuroimaging data, treatment details, and outcome information were prospectively collected.…”

“…The aim of this study was to compare the outcome of patients with acute ischemic stroke due to proximal intracranial artery occlusion in the anterior cerebral circulation, eligible for IVT according to current guidelines, treated with combined therapy with those who underwent primary MT, included in the Italian Registry of Endovascular Stroke Treatments. 28…”