Trends in Use of Intravenous Thrombolysis and Endovascular Thrombectomy in Patients With Acute Stroke With Large Vessel Occlusion 2016 to 2020 and Impact of COVID‐19 Pandemic

Khunte, Mihir; Chen, Huanwen; Khunte, Akshay; Payabvash, Seyedmehdi; Gandhi, Dheeraj; Malhotra, Ajay

doi:10.1161/jaha.122.029579

JAHA

2023

DOI: 10.1161/jaha.122.029579

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Trends in Use of Intravenous Thrombolysis and Endovascular Thrombectomy in Patients With Acute Stroke With Large Vessel Occlusion 2016 to 2020 and Impact of COVID‐19 Pandemic

Mihir Khunte,

Huanwen Chen,

Akshay Khunte

et al.

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2024

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Mechanical thrombectomy failure in anterior and posterior circulation stroke: current results from a high-volume comprehensive center

Neumann,

Schildhauer,

Weiler

et al. 2024

Neurol Sci

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Background Mechanical thrombectomy (MT) is an established therapy for acute ischemic stroke (AIS), but recanalization is not always achieved. Common reasons are inadequate removal at the thrombus site and difficulties with the access route. In order to identify risk factors for MT failure we conducted a retrospective study on a high-volume comprehensive stroke center. Methods Evaluation of 552 thrombectomies (2019-23; anterior and posterior circulation, direct aspiration +/- stent retriever [SR]). MT failures (= modified Thrombolysis in Cerebral Infarction score 0 or 1) were analyzed for age, sex, pre- and post-MT modified Rankin Scale, bridging intravenous thrombolysis (IVT), occlusion site (anterior / posterior circulation, proximal / distal), the Kaesmacher classification and time trend results. Results MT failure occurred in 56 patients (10.1%; median age 76; 53.6% female). Nineteen (33.9%) patients received IVT (p = 0.326). Logistic regression analysis did not show a significant association of age, sex or occlusion site with MT failure (p = 0.165, p = 0.738, p = 0.838). Distal MT generally demonstrated lower success rates (p < 0.01). According to the Kaesmacher classification SR failure was the most frequent cause of MT failure (category 2B: 48%, p < 0.001). Time trend analysis suggests improving recanalization rates in the further course (4 times in year-on-year comparison; p < 0.01). Conclusion MT failure occurs in AIS treatment, even in high-volume centers and occurs more frequently in distal occlusions. Improvements in device technology, particularly SR, and ongoing refinements in access route selection offer the prospect of better outcomes in the future.

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Mechanical thrombectomy failure in anterior and posterior circulation stroke: current results from a high-volume comprehensive center

Neumann,

Schildhauer,

Weiler

et al. 2024

Neurol Sci

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Intravenous Thrombolysis in Acute Ischaemic Stroke Two Years into the COVID-19 Pandemic: A Retrospective Study

Jala,

Bertmar,

Fry

et al. 2024

Australasian Journal of Neuroscience

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Introduction Changes in intravenous thrombolysis treatment rates for acute ischaemic stroke during the COVID-19 pandemic have been reported. We examined the differences in the provision of intravenous thrombolysis in patients with acute ischaemic stroke, two years prior to and two years into the COVID-19 pandemic. Methods Data were compared between March 1, 2018 to February 28, 2020 (Pre-COVID-19) and March 1, 2020 to February 28, 2022 (COVID-19). Data collected included patients’ demographics, intravenous thrombolysis rates, and patient outcomes. Results There was an increase in ischaemic stroke patient admissions during the COVID-19 period (Pre-COVID-19 n=1041, vs COVID-19 n=1087). Yet, fewer stroke patients received intravenous thrombolysis (19.2% vs 13.9%, p<0.001), and there were more stroke mimics thrombolysed (8.3% vs 15.6%, p=0.021) during this period. During the COVID-19 period, there was a significant delay in hospital presentation for patients who were thrombolysed (Pre-COVID-19 = 86 minutes vs COVID-19 = 107 minutes, p = 0.004); and delay in giving thrombolysis (median door to needle time: Pre-COVID-19 = 59 minutes vs COVID-19 = 65 minutes, p = 0.002). Fewer patients had severe stroke symptoms (National Institute of Health Stroke Scale score = >15) (12.2% vs 4.8%, p=0.009) during the COVID-19 period. There was no significant difference in patients’ post-thrombolysis outcome (median National Institute of Health Stroke Scale score = 1, p=0.136; discharge modified Rankin Scale score = 1, p=0.647; and mortality p=0.655). Conclusion This study showed that during the first 2 years of the COVID-19 pandemic, there was a significant decline in the thrombolysis rates and delay in the administration of the intravenous thrombolysis treatment.

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Trends in Use of Intravenous Thrombolysis and Endovascular Thrombectomy in Patients With Acute Stroke With Large Vessel Occlusion 2016 to 2020 and Impact of COVID‐19 Pandemic

Cited by 2 publications

References 5 publications

Mechanical thrombectomy failure in anterior and posterior circulation stroke: current results from a high-volume comprehensive center

Mechanical thrombectomy failure in anterior and posterior circulation stroke: current results from a high-volume comprehensive center

Intravenous Thrombolysis in Acute Ischaemic Stroke Two Years into the COVID-19 Pandemic: A Retrospective Study

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