Impact of introducing endovascular treatment on acute ischemic stroke outcomes: A shift from an era of medical management to thrombectomy in Japan.
Acute ischemic stroke
Clinical research
Emergency medicine
Endovascular treatment
Helicopter transport
Internal medicine
Intravenous thrombolysis
Large vessel occlusion
Mechanical thrombectomy
Neurology
Neurosurgery
Radiology
Journal
Heliyon
ISSN: 2405-8440
Titre abrégé: Heliyon
Pays: England
ID NLM: 101672560
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
30
12
2019
revised:
24
04
2020
accepted:
05
05
2020
entrez:
20
5
2020
pubmed:
20
5
2020
medline:
20
5
2020
Statut:
epublish
Résumé
Endovascular treatment (EVT) has increasingly become the standard treatment of acute cerebral large vessel occlusion (LVO). We evaluated the impact of introducing EVT on LVO therapy in a single center where intravenous thrombolysis (IVT) had been the only recanalization therapy. Between April 2013 and March 2017, 354 consecutive patients with LVO admitted to our institution were analyzed. We compared outcomes between two chronological groups before (Pre-EVT group) and after (Post-EVT group) introducing EVT in April 2015. We assessed prognostic factors for favorable outcomes (modified Rankin scale score ≤2 at 90 days). In the Pre-EVT group, all 140 patients were treated medically, including 30 patients (21%) undergoing IVT. In the Post-EVT group, 118 patients (55%) underwent EVT, and the remaining 96 patients treated medically, including six patients (3%) undergoing IVT. The proportion undergoing recanalization therapy with IVT or EVT significantly increased after introducing EVT (21% versus 58%, p < 0.001). The rate of patients achieving favorable outcomes also significantly increased (14% versus 31%, p < 0.001). In multivariate regression analysis, introducing EVT was an independent predictive factor after adjusting for age, stroke severity and extent, and time (p = 0.005). The arrival time in patients with helicopter transport was significantly shorter than that with ground ambulance for a distance of more than 10 km (p < 0.001). This study demonstrated that the introduction of EVT improved outcomes of acute LVO patients, increasing the opportunity to receive recanalization therapy. Further efforts to establish medical systems to provide EVT are required throughout the country.
Sections du résumé
BACKGROUND
BACKGROUND
Endovascular treatment (EVT) has increasingly become the standard treatment of acute cerebral large vessel occlusion (LVO). We evaluated the impact of introducing EVT on LVO therapy in a single center where intravenous thrombolysis (IVT) had been the only recanalization therapy.
MATERIALS AND METHODS
METHODS
Between April 2013 and March 2017, 354 consecutive patients with LVO admitted to our institution were analyzed. We compared outcomes between two chronological groups before (Pre-EVT group) and after (Post-EVT group) introducing EVT in April 2015. We assessed prognostic factors for favorable outcomes (modified Rankin scale score ≤2 at 90 days).
RESULTS
RESULTS
In the Pre-EVT group, all 140 patients were treated medically, including 30 patients (21%) undergoing IVT. In the Post-EVT group, 118 patients (55%) underwent EVT, and the remaining 96 patients treated medically, including six patients (3%) undergoing IVT. The proportion undergoing recanalization therapy with IVT or EVT significantly increased after introducing EVT (21% versus 58%, p < 0.001). The rate of patients achieving favorable outcomes also significantly increased (14% versus 31%, p < 0.001). In multivariate regression analysis, introducing EVT was an independent predictive factor after adjusting for age, stroke severity and extent, and time (p = 0.005). The arrival time in patients with helicopter transport was significantly shorter than that with ground ambulance for a distance of more than 10 km (p < 0.001).
CONCLUSIONS
CONCLUSIONS
This study demonstrated that the introduction of EVT improved outcomes of acute LVO patients, increasing the opportunity to receive recanalization therapy. Further efforts to establish medical systems to provide EVT are required throughout the country.
Identifiants
pubmed: 32426544
doi: 10.1016/j.heliyon.2020.e03945
pii: S2405-8440(20)30790-8
pii: e03945
pmc: PMC7226659
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e03945Informations de copyright
© 2020 The Author(s).
Références
N Engl J Med. 2015 Jun 11;372(24):2285-95
pubmed: 25882376
N Engl J Med. 2018 Feb 22;378(8):708-718
pubmed: 29364767
Stroke. 2011 May;42(5):1295-300
pubmed: 21441156
N Engl J Med. 2015 Jan 1;372(1):11-20
pubmed: 25517348
N Engl J Med. 2015 Mar 12;372(11):1009-18
pubmed: 25671797
World Neurosurg. 2018 Dec 28;:
pubmed: 30597281
BMJ. 2018 Mar 9;360:k949
pubmed: 29523557
Int J Stroke. 2008 Feb;3(1):55-62
pubmed: 18705916
Lancet. 2016 Apr 23;387(10029):1723-31
pubmed: 26898852
World Neurosurg. 2020 Jan;133:150-154
pubmed: 31589986
Neurology. 2017 Jan 31;88(5):441-448
pubmed: 28053009
Stroke. 2014 Jul;45(7):1977-84
pubmed: 24876082
N Engl J Med. 2015 Mar 12;372(11):1019-30
pubmed: 25671798
J Stroke Cerebrovasc Dis. 2017 Dec;26(12):2793-2799
pubmed: 28754235
N Engl J Med. 2018 Jan 4;378(1):11-21
pubmed: 29129157
Stroke. 2007 Mar;38(3):967-73
pubmed: 17272772
J Neurointerv Surg. 2018 Jun;10(6):516-524
pubmed: 28963367
N Engl J Med. 2015 Jun 11;372(24):2296-306
pubmed: 25882510
Neurol Med Chir (Tokyo). 2017 Mar 15;57(3):128-135
pubmed: 28025467
World Neurosurg. 2019 Jul;127:492-499
pubmed: 31009772
Air Med J. 2015 Nov-Dec;34(6):348-56
pubmed: 26611222