A multicenter study of the safety and effectiveness of mechanical thrombectomy for patients with acute ischemic stroke not meeting top-tier evidence criteria
Language English Country Great Britain, England Media print-electronic
Document type Journal Article, Multicenter Study, Observational Study
PubMed
28143898
DOI
10.1136/neurintsurg-2016-012905
PII: neurintsurg-2016-012905
Knihovny.cz E-resources
- Keywords
- Stroke, Thrombectomy,
- MeSH
- Stroke diagnostic imaging therapy MeSH
- Adult MeSH
- Brain Ischemia diagnostic imaging therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Mechanical Thrombolysis adverse effects methods MeSH
- Prospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Thrombectomy adverse effects methods MeSH
- Patient Selection MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
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.
Australian Catholic University Sydney New South Wales Australia
Cerebrovascular Program Vanderbilt University Nashville Tennessee USA
Department of Interventional Neuroradiology Erlanger Hospital Chattanooga Tennessee USA
Department of Interventional Neuroradiology Radiology Imaging Associates Englewood Colorado USA
Department of Neurology University of Tennessee Health Science Center Memphis Tennessee USA
Department of Neurosurgery Medical University of South Carolina Charleston South Carolina USA
Department of Neurosurgery Mount Sinai Medical Center New York New York USA
International Clinical Research Center St Anne's Hospital Brno Czech Republic
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