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A multicenter study of the safety and effectiveness of mechanical thrombectomy for patients with acute ischemic stroke not meeting top-tier evidence criteria

N. Goyal, G. Tsivgoulis, D. Frei, A. Turk, B. Baxter, MT. Froehler, J. Mocco, J. Vachhani, D. Hoit, L. Elijovich, D. Loy, RD. Turner, J. Mascitelli, K. Espaillat, AV. Alexandrov, AW. Alexandrov, AS. Arthur,

. 2018 ; 10 (1) : 10-16. [pub] 20170131

Jazyk angličtina Země Anglie, Velká Británie

Typ dokumentu časopisecké články, multicentrická studie, pozorovací studie

Perzistentní odkaz   https://www.medvik.cz/link/bmc18025177

BACKGROUND: While mechanical thrombectomy (MT) has become the standard of care for patients with acute ischemic stroke (AIS) with emergent large-vessel occlusions (ELVO), recently published guidelines appropriately award top-tier evidence to the same selective criteria that were employed in completed clinical trials. We sought to evaluate the safety and effectiveness of MT in patients with AIS with ELVO who do not meet top-tier evidence criteria (TTEC). METHODS: We conducted an observational study on consecutive patients with AIS with ELVO who underwent MT at six high-volume endovascular centers. Standard safety outcomes (3-month mortality, symptomatic intracranial hemorrhage) and effectiveness outcomes (3-month functional independence: modified Rankin Scale scores of 0-2) were compared between patients meeting and failing TTEC. RESULTS: The sample consisted of 349 (60%) controls fulfilling TTEC and 234 (40%) non-TTEC patients. Control patients meeting TTEC for MT tended to have higher functional independence rates at 3 months (47% vs 39%; p=0.055), while the rates of symptomatic intracerebral hemorrhage (sICH) were similar (9%) in both groups (p=0.983). In multivariable logistic regression models, adherence to TTEC for MT was not independently related to any safety outcome (sICH: OR 0.71, 95% CI 0.30 to 1.68, p=0.434; 3-month mortality: OR 1.27, 95% CI 0.69 to 2.33, p=0.448) or effectiveness outcome (3-month functional independence: OR 0.81, 95% CI 0.48 to 1.37, p=0.434; 3-month functional improvement: OR 0.73, 95% CI 0.48 to 1.11, p=0.138) after adjusting for potential confounders. CONCLUSIONS: Approximately 40% of patients with AIS with ELVO offered MT do not fulfill TTEC for MT. Patients who did not meet TTEC had high rates of good clinical outcome and low complication rates.

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$a BACKGROUND: While mechanical thrombectomy (MT) has become the standard of care for patients with acute ischemic stroke (AIS) with emergent large-vessel occlusions (ELVO), recently published guidelines appropriately award top-tier evidence to the same selective criteria that were employed in completed clinical trials. We sought to evaluate the safety and effectiveness of MT in patients with AIS with ELVO who do not meet top-tier evidence criteria (TTEC). METHODS: We conducted an observational study on consecutive patients with AIS with ELVO who underwent MT at six high-volume endovascular centers. Standard safety outcomes (3-month mortality, symptomatic intracranial hemorrhage) and effectiveness outcomes (3-month functional independence: modified Rankin Scale scores of 0-2) were compared between patients meeting and failing TTEC. RESULTS: The sample consisted of 349 (60%) controls fulfilling TTEC and 234 (40%) non-TTEC patients. Control patients meeting TTEC for MT tended to have higher functional independence rates at 3 months (47% vs 39%; p=0.055), while the rates of symptomatic intracerebral hemorrhage (sICH) were similar (9%) in both groups (p=0.983). In multivariable logistic regression models, adherence to TTEC for MT was not independently related to any safety outcome (sICH: OR 0.71, 95% CI 0.30 to 1.68, p=0.434; 3-month mortality: OR 1.27, 95% CI 0.69 to 2.33, p=0.448) or effectiveness outcome (3-month functional independence: OR 0.81, 95% CI 0.48 to 1.37, p=0.434; 3-month functional improvement: OR 0.73, 95% CI 0.48 to 1.11, p=0.138) after adjusting for potential confounders. CONCLUSIONS: Approximately 40% of patients with AIS with ELVO offered MT do not fulfill TTEC for MT. Patients who did not meet TTEC had high rates of good clinical outcome and low complication rates.
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$a Tsivgoulis, Georgios $u Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. Second Department of Neurology, "Attikon University Hospital", School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. International Clinical Research Center, St. Anne's Hospital, Brno, Czech Republic.
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$a Frei, Donald $u Department of Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA.
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$a Turk, Aquilla $u Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
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$a Baxter, Blaise $u Department of Interventional Neuroradiology, Erlanger Hospital, Chattanooga, Tennessee, USA.
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$a Froehler, Michael T $u Cerebrovascular Program, Vanderbilt University, Nashville, Tennessee, USA.
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$a Mocco, J $u Department of Neurosurgery, Mount Sinai Medical Center, New York, New York, USA.
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$a Vachhani, Jay $u Department of Neurosurgery, University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis, Tennessee, USA.
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$a Hoit, Daniel $u Department of Neurosurgery, University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis, Tennessee, USA.
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$a Elijovich, Lucas $u Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. Department of Neurosurgery, University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis, Tennessee, USA.
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$a Loy, David $u Department of Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA.
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$a Turner, Raymond D $u Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
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$a Mascitelli, Justin $u Department of Neurosurgery, Mount Sinai Medical Center, New York, New York, USA.
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$a Espaillat, Kiersten $u Cerebrovascular Program, Vanderbilt University, Nashville, Tennessee, USA.
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$a Alexandrov, Andrei V $u Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
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$a Alexandrov, Anne W $u Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. Australian Catholic University, Sydney, New South Wales, Australia.
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$a Arthur, Adam S $u Department of Neurosurgery, University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis, Tennessee, USA.
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