Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study

BMC Neurology

Götz Thomalla¹  Christian Gerloff¹  Anna Alegiani¹  Milani Deb-Chatterji¹  Hannes Leischner²  Fabian Flottmann²  Caspar Brekenfeld²  Jens Fiehler²  Hans Pinnschmidt³ 

[1] Department of Neurology, University Medical Center Hamburg-Eppendorf;Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg-Eppendorf;Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf;

关键词: Stroke;    Thrombectomy;    Reperfusion;    Basilar artery occlusion;    Clinical practice;   

DOI  :  10.1186/s12883-020-01653-z

来源: DOAJ

【 摘 要 】

Abstract Background Randomized controlled trials (RCTs) demonstrated efficacy and safety of endovascular treatment (ET) in anterior circulation large vessel occlusions (LVO). We aimed at investigating how stroke patients treated by thrombectomy in clinical practice and their outcome compare to cohorts and results of thrombectomy trials. Methods In a prospective study, we consecutively included stroke patients treated by thrombectomy (2015–2017). Baseline characteristics, procedural and outcome data were analyzed. Outcome was assessed by modified Rankin Scale (mRS) at 90 days. Ordinal regression analysis was performed to identify predictors of outcome. Results Thrombectomy was applied in 264 patients (median 75 years, 49.6% female). Median baseline National Institutes of Health Stroke Scale (NIHSS) was 16, 58.0% received concomitant intravenous thrombolysis, 62.1% were referred from external hospitals. Median Alberta Stroke Program Early CT Score (ASPECTS) was 7. Successful recanalization (modified Thrombolysis in Cerebral Infarction Score, mTICI 2b/3) was achieved in 72.0%. Symptomatic intracranial hemorrhage (sICH) occurred in 4.5%. Independent outcome (mRS 0–2) was achieved in 26.2%, poor outcome (mRS 5–6) in 49.2%. Only 33.5% met the stringent enrolment criteria of previous RCTs. Lower age, baseline NIHSS, pre-stroke mRS, higher ASPECTS, and successful recanalization were independent predictors of favourable outcome. Conclusions The majority of stroke patients treated by ET in clinical practice would not have qualified for randomization in prior RCTs. Outcome in real-life patient cohorts is worse than in the highly selected cohorts from randomized trials, while rates of successful recanalization, sICH and outcome predictors are the same. Our findings support ET in broader patient populations than in the RCTs and may improve treatment decision in individual stroke patients with LVO in clinical practice.

【 授权许可】

Unknown