Clinical effectiveness of endovascular stroke treatment in the early and extended time windows

Raul G. Nogueira, Department of Neurology, 12239Emory University School of Medicine, Marcus Stroke & Neuroscience Center, 71741Grady Memorial Hospital, Atlanta, GA, USA.Follow
Diogo C. Haussen, Department of Neurology, 12239Emory University School of Medicine, Marcus Stroke & Neuroscience Center, 71741Grady Memorial Hospital, Atlanta, GA, USA.
David S. Liebeskind, Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles (8783UCLA), Los Angeles, CA, USA.
Tudor G. Jovin, Department of Neurology, 2202Cooper University Hospital Neurological Institute, Camden, NJ, USA.Follow
Rishi Gupta, Department of Neurosciences, Wellstar Health System, Atlanta, GA, USA.Follow
Jeffrey L. Saver, Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles (8783UCLA), Los Angeles, CA, USA.
Ashutosh P. Jadhav, Department of Neurology, Stroke Institute, 6614University of Pittsburgh Medical Center, PA, USA.Follow
Ronald F. Budzik, Department of Interventional Neuroradiology, 24601Riverside Methodist Hospital/Ohio Health Research Institute, Columbus, OH, USA.Follow
Blaise W. Baxter MD, Lehigh Valley Health NetworkFollow
Antonin Krajina, Department of Radiology, University Hospital Hradec Kralove, Czech Republic.
Alain Bonafe, Department of Neuroradiology, CHU Montpellier, France.
Ali Malek, St. Mary's Medical Center, West Palm Beach, FL, USA.
Ana Paula Narata, Department of Neuroradiology, CHU Tours, France.
Mahmoud H. Mohammaden, Department of Neurology, 12239Emory University School of Medicine, Marcus Stroke & Neuroscience Center, 71741Grady Memorial Hospital, Atlanta, GA, USA.
Yanchang Zhang, 347070Stryker Neurovascular, Fremont, CA, USA.
Patricia Morgan, 347070Stryker Neurovascular, Fremont, CA, USA.
Minyi Ji, 347070Stryker Neurovascular, Fremont, CA, USA.
Bruno Bartolini, Department of Radiology, Interventional Neuroradiology Unit, 30635Lausanne University Hospital, Lausanne, Switzerland.Follow
Joey English, Department of Neurology, 7153California Pacific Medical Center, San Francisco, CA, USA.Follow
Gregory W. Albers, Department of Neurology, Stanford Stroke Center, Palo Alto, CA, USA.

Document Type

Article

Publication Date

4-20-2021

Publication Title

International journal of stroke : official journal of the International Stroke Society

E-ISSN

1747-4949

Department(s)

Department of Radiology and Diagnostic Medical Imaging

Keywords

Stroke, registry, thrombectomy

Abstract

BACKGROUND: The clinical efficacy of mechanical thrombectomy has been unequivocally demonstrated in multiple randomized clinical trials. However, these studies were performed in carefully selected centers and utilized strict inclusion criteria. AIM: We aimed to assess the clinical effectiveness of mechanical thrombectomy in a prospective registry. METHODS: A total of 2008 patients from 76 sites across 12 countries were enrolled in a prospective open-label mechanical thrombectomy registry. Patients were categorized into the corresponding cohorts of the SWIFT-Prime, DAWN, and DEFUSE 3 trials according to the basic demographic and clinical criteria without considering specific parenchymal imaging findings. Baseline and outcome variables were compared across the corresponding groups. RESULTS: As compared to the treated patients in the actual trials, registry-derived patients tended to be younger and had lower baseline ASPECTS. In addition, time to treatment was earlier and the use of intravenous tissue plasminogen activator (IV-tPA) and general anesthesia were higher in DAWN- and DEFUSE-3 registry derived patients versus their corresponding trials. Reperfusion rates were higher in the registry patients. The rates of 90-day good outcome (mRS0-2) in registry-derived patients were comparable to those of the patients treated in the corresponding randomized clinical trials (SWIFT-Prime, 64.5% vs. 60.2%; DAWN, 50.4% vs. 48.6%; Beyond-DAWN: 52.4% vs. 48.6%; DEFUSE 3, 52% vs. 44.6%, respectively; all  > 0.05). Registry-derived patients had significant less disability than the corresponding randomized clinical trial controls (ordinal modified Rankin Scale (mRS) shift odds ratio (OR),  < 0.05 for all). CONCLUSION: Our study provides favorable generalizability data for the safety and efficacy of thrombectomy in the "real-world" setting and supports that patients may be safely treated outside the constraints of randomized clinical trials.

First Page

17474930211005740

DOI

10.1177/17474930211005740

PubMed ID

33705210

Link to Full Text

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