Recanalization treatment for acute ischemic stroke: 3-month outcome before and after implementation of routine endovascular treatment.
Endovascular treatment
Functional outcome
Intravenous thrombolysis
Ischemic stroke
Journal
eNeurologicalSci
ISSN: 2405-6502
Titre abrégé: eNeurologicalSci
Pays: Netherlands
ID NLM: 101667077
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
received:
22
03
2021
revised:
18
02
2022
accepted:
23
02
2022
entrez:
8
3
2022
pubmed:
9
3
2022
medline:
9
3
2022
Statut:
epublish
Résumé
Endovascular treatment for acute ischemic stroke has become a recommended treatment option for selected patients after several randomized controlled trials have shown the effectiveness of endovascular treatment. Due to the nature of randomized clinical trials, the generalizability to population based real life settings and the resulting benefits remain difficult to estimate. We included 896 consecutive patients treated with intravenous thrombolysis (IVT) within 4.5 h of stroke onset between January 2016 and December 2018, who were treated with additional endovascular treatment according to the new evidence when indicated (new-IVT-cohort). This cohort was compared to 913 intravenous thrombolysis patients treated in the 4.5 h time-window between January 2011 and December 2013 before the era of endovascular treatment (old-IVT-cohort). In the new-IVT-cohort there were 253 intravenous thrombolysis + endovascular treatment treated patients. The new-IVT-cohort was associated with a better outcome on the modified Rankin Scale at 3 months in univariable ordinal regression (OR 1.27; 95% CI 1.08-1.49). The association remained significant (OR 1.65; 95% CI 1.27-2.14) also after adjustment for following confounding factors: sex, NIHSS, diabetes, atrial fibrillation, hypertension, coronary artery disease, hypercholesterolemia, myocardial infarction, heart failure, history of ischemic stroke, history of TIA, and use of antithrombotic, statins, antihypertensive, anticoagulation treatment, or endovascular treatment (Fig. 1). We were able to verify the efficacy of endovascular treatment in a real life cohort of intravenous thrombolysis patients even when only 28% of the patients are eligible for endovascular treatment on top of intravenous thrombolysis treatment.
Sections du résumé
Background and purpose
UNASSIGNED
Endovascular treatment for acute ischemic stroke has become a recommended treatment option for selected patients after several randomized controlled trials have shown the effectiveness of endovascular treatment. Due to the nature of randomized clinical trials, the generalizability to population based real life settings and the resulting benefits remain difficult to estimate.
Methods
UNASSIGNED
We included 896 consecutive patients treated with intravenous thrombolysis (IVT) within 4.5 h of stroke onset between January 2016 and December 2018, who were treated with additional endovascular treatment according to the new evidence when indicated (new-IVT-cohort). This cohort was compared to 913 intravenous thrombolysis patients treated in the 4.5 h time-window between January 2011 and December 2013 before the era of endovascular treatment (old-IVT-cohort).
Results
UNASSIGNED
In the new-IVT-cohort there were 253 intravenous thrombolysis + endovascular treatment treated patients. The new-IVT-cohort was associated with a better outcome on the modified Rankin Scale at 3 months in univariable ordinal regression (OR 1.27; 95% CI 1.08-1.49). The association remained significant (OR 1.65; 95% CI 1.27-2.14) also after adjustment for following confounding factors: sex, NIHSS, diabetes, atrial fibrillation, hypertension, coronary artery disease, hypercholesterolemia, myocardial infarction, heart failure, history of ischemic stroke, history of TIA, and use of antithrombotic, statins, antihypertensive, anticoagulation treatment, or endovascular treatment (Fig. 1).
Conclusion
UNASSIGNED
We were able to verify the efficacy of endovascular treatment in a real life cohort of intravenous thrombolysis patients even when only 28% of the patients are eligible for endovascular treatment on top of intravenous thrombolysis treatment.
Identifiants
pubmed: 35257032
doi: 10.1016/j.ensci.2022.100394
pii: S2405-6502(22)00003-X
pmc: PMC8897574
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100394Informations de copyright
© 2022 Published by Elsevier B.V.
Déclaration de conflit d'intérêts
None.
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