Temporal Changes in Care Processes and Outcomes for Endovascular Treatment of Acute Ischemic Stroke: Retrospective Registry Data from Three Korean Centers

Neurointervention

Andrew M. Demchuk¹  Seong-Joon Lee²  Jin Soo Lee²  Ji Man Hong²  Jeong-Ho Hong³  Sung-Il Sohn³  Yong-Won Kim⁴  Yang-Ha Hwang⁴  Bruce Ovbiagele⁵  Chang-Hyun Kim⁶  Jin Wook Choi⁷  Hyuk-Won Chang⁸  Dong-Hun Kang⁹  Yong-Sun Kim⁹ 

[1] Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada.;Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.;Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.;Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.;Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.;Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea.;Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.;Department of Radiology, Keimyung University Dongsan Medical Center, Daegu, Korea.;Department of Radiology, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.;

关键词: cerebral infarction;    thrombectomy;    reperfusion;    cerebral hemorrhage;    learning curve;    treatment outcome;   

DOI  :  10.5469/neuroint.2018.13.1.2

来源: DOAJ

【 摘 要 】

Background and PurposeThe purpose of the current study is to evaluate the influence of temporal patterns related to the availability of new endovascular treatment (EVT) devices on care processes and outcomes among patients with AIS.Materials and MethodsWe enrolled 720 consecutive patients (January 2011 to May 2016) in a retrospective registry, ASIAN KR, from three Korean hospitals, who received EVT for acute ischemic stroke (AIS) caused by cervicocephalic arterial occlusions. We performed period-to-period analyses based on stent retriever reimbursement and the availability of second-generation direct-aspiration devices (Period 1: January 2011–July 2014 vs. Period 2: August 2014–May 2016); time metrics and outcomes were compared when the onset-to-puncture time was <720 min among patients with EVT for intracranial occlusion.ResultsPeriod 2 had better post-EVT outcomes (3-month modified Rankin Scale 0–2 or equal to prestroke score, 48.3% vs. 60.2%, P=0.004), more successful reperfusion rates (modified Treatment In Cerebral Ischemia 2b–3, 74.2% vs. 82.2%, P=0.019), fewer subarachnoid hemorrhages (modified Fisher grade 3–4, 5.5% vs. 2.0%, P=0.034) and lower hemorrhagic transformation rates (any intracerebral hemorrhage, 35.3 vs. 22.7%, P=0.001) than Period 1. Compared to Period 1, Period 2 had a shorter door-to-puncture time (median 109 vs. 90 min, P<0.001), but longer onset-to-door time (129 vs. 143 min, P=0.057).ConclusionRecent temporal improvements in post-EVT AIS outcomes in Korea are likely due to a combination of enhanced hospital care processes and administration of newer thrombectomy devices.

【 授权许可】

Unknown