Access to mechanical thrombectomy for cerebral ischaemia: A population-based study in the North-of-France.
Aged
Aged, 80 and over
Brain Ischemia
/ epidemiology
Cerebral Infarction
/ epidemiology
Female
Fibrinolytic Agents
/ therapeutic use
France
/ epidemiology
Health Services Accessibility
/ standards
Hospitals, Private
/ statistics & numerical data
Hospitals, Public
/ statistics & numerical data
Humans
Male
Mechanical Thrombolysis
/ methods
Middle Aged
Stroke
/ epidemiology
Thrombectomy
/ methods
Treatment Outcome
Cerebral infarct
Cerebral ischaemia
Population-based study
Stroke
Stroke care
Stroke management
Thrombectomy
Thrombolysis
Journal
Revue neurologique
ISSN: 0035-3787
Titre abrégé: Rev Neurol (Paris)
Pays: France
ID NLM: 2984779R
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
18
11
2018
accepted:
18
12
2018
pubmed:
19
6
2019
medline:
1
5
2020
entrez:
19
6
2019
Statut:
ppublish
Résumé
Hospitals admitting acute strokes should offer access to mechanical thrombectomy (MT), but local organisations are still based on facilities available before MT was proven effective. MT rates and outcomes at population levels are needed to adapt organisations. We evaluated rates of MT and outcomes in inhabitants from the North-of-France (NoF) area. We prospectively evaluated rates of MT and outcomes of patients at 3 months, good outcomes being defined as a modified Rankin scale (mRS) 0 to 2 or like the pre-stroke mRS. During the study period (2016-2017), 666 patients underwent MT (454, 68.1% associated with intravenous thrombolysis [IVT]). Besides, 1595 other patients received IVT alone. The rate of MT was 81 (95% confidence interval [CI] 72-90) per million inhabitants-year, ranging from 36 to 108 between districts. The rate of IVT was 249 (95% CI 234-264) per million inhabitants-year, ranging from 155 to 268. After 3 months, 279 (41.9%) patients who underwent MT had good outcomes, and 167 (25.1%) had died. Patients living outside the district of Lille where the only MT centre is, were less likely to have good outcomes at 3 months, after adjustment on age, sex, baseline severity, and delay. The rate of MT is one of the highest reported up to now, even in low-rate districts, but outcomes were significantly worse in patients living outside the district of Lille, and this is not only explained by the delay.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Hospitals admitting acute strokes should offer access to mechanical thrombectomy (MT), but local organisations are still based on facilities available before MT was proven effective. MT rates and outcomes at population levels are needed to adapt organisations. We evaluated rates of MT and outcomes in inhabitants from the North-of-France (NoF) area.
METHOD
METHODS
We prospectively evaluated rates of MT and outcomes of patients at 3 months, good outcomes being defined as a modified Rankin scale (mRS) 0 to 2 or like the pre-stroke mRS.
RESULTS
RESULTS
During the study period (2016-2017), 666 patients underwent MT (454, 68.1% associated with intravenous thrombolysis [IVT]). Besides, 1595 other patients received IVT alone. The rate of MT was 81 (95% confidence interval [CI] 72-90) per million inhabitants-year, ranging from 36 to 108 between districts. The rate of IVT was 249 (95% CI 234-264) per million inhabitants-year, ranging from 155 to 268. After 3 months, 279 (41.9%) patients who underwent MT had good outcomes, and 167 (25.1%) had died. Patients living outside the district of Lille where the only MT centre is, were less likely to have good outcomes at 3 months, after adjustment on age, sex, baseline severity, and delay.
CONCLUSION
CONCLUSIONS
The rate of MT is one of the highest reported up to now, even in low-rate districts, but outcomes were significantly worse in patients living outside the district of Lille, and this is not only explained by the delay.
Identifiants
pubmed: 31208814
pii: S0035-3787(18)30934-2
doi: 10.1016/j.neurol.2018.12.010
pii:
doi:
Substances chimiques
Fibrinolytic Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
519-527Informations de copyright
Copyright © 2019 Elsevier Masson SAS. All rights reserved.