A multicenter study of the safety and effectiveness of mechanical thrombectomy for patients with acute ischemic stroke not meeting top-tier evidence criteria
- 31 January 2017
- journal article
- research article
- Published by BMJ in Journal of NeuroInterventional Surgery
- Vol. 10 (1), 10-16
- https://doi.org/10.1136/neurintsurg-2016-012905
Abstract
Background While mechanical thrombectomy (MT) has become the standard of care for patients with acute ischemic stroke (AIS) with emergent large-vessel occlusions (ELVO), recently published guidelines appropriately award top-tier evidence to the same selective criteria that were employed in completed clinical trials. We sought to evaluate the safety and effectiveness of MT in patients with AIS with ELVO who do not meet top-tier evidence criteria (TTEC). Methods We conducted an observational study on consecutive patients with AIS with ELVO who underwent MT at six high-volume endovascular centers. Standard safety outcomes (3-month mortality, symptomatic intracranial hemorrhage) and effectiveness outcomes (3-month functional independence: modified Rankin Scale scores of 0–2) were compared between patients meeting and failing TTEC. Results The sample consisted of 349 (60%) controls fulfilling TTEC and 234 (40%) non-TTEC patients. Control patients meeting TTEC for MT tended to have higher functional independence rates at 3 months (47% vs 39%; p=0.055), while the rates of symptomatic intracerebral hemorrhage (sICH) were similar (9%) in both groups (p=0.983). In multivariable logistic regression models, adherence to TTEC for MT was not independently related to any safety outcome (sICH: OR 0.71, 95% CI 0.30 to 1.68, p=0.434; 3-month mortality: OR 1.27, 95% CI 0.69 to 2.33, p=0.448) or effectiveness outcome (3-month functional independence: OR 0.81, 95% CI 0.48 to 1.37, p=0.434; 3-month functional improvement: OR 0.73, 95% CI 0.48 to 1.11, p=0.138) after adjusting for potential confounders. Conclusions Approximately 40% of patients with AIS with ELVO offered MT do not fulfill TTEC for MT. Patients who did not meet TTEC had high rates of good clinical outcome and low complication rates.Keywords
This publication has 26 references indexed in Scilit:
- Heart Disease and Stroke Statistics—2015 UpdateCirculation, 2015
- A Randomized Trial of Intraarterial Treatment for Acute Ischemic StrokeThe New England Journal of Medicine, 2015
- Factors Affecting Clinical Outcome in Large-Vessel Occlusive Ischemic StrokesInternational Journal of Stroke, 2014
- Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysisJournal of NeuroInterventional Surgery, 2014
- Endovascular Treatment for Acute Ischemic Stroke — Still UnprovenThe New England Journal of Medicine, 2013
- Current treatment of basilar artery occlusionAnnals of the New York Academy of Sciences, 2012
- Imaging-based treatment selection for intravenous and intra-arterial stroke therapies: a comprehensive reviewExpert Review of Cardiovascular Therapy, 2011
- Prevalence and Risk Factors Associated With Reversed Robin Hood Syndrome in Acute Ischemic StrokeStroke, 2009
- Treatment effects for which shift or binary analyses are advantageous in acute stroke trialsNeurology, 2009
- Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational studyThe Lancet, 2007