Functional Outcome Following Stroke Thrombectomy in Clinical Practice

TY - JOUR

T1 - Functional Outcome Following Stroke Thrombectomy in Clinical Practice

AU - Wollenweber, Frank A

AU - Tiedt, Steffen

AU - Alegiani, Anna

AU - Alber, Burkhard

AU - Bangard, Christopher

AU - Berrouschot, Jörg

AU - Bode, Felix J

AU - Boeckh-Behrens, Tobias

AU - Bohner, Georg

AU - Bormann, Albrecht

AU - Braun, Michael

AU - Dorn, Franziska

AU - Eckert, Bernd

AU - Flottmann, Fabian

AU - Hamann, Gerhard F

AU - Henn, Karl-Heinz

AU - Herzberg, Moriz

AU - Kastrup, Andreas

AU - Kellert, Lars

AU - Kraemer, Christoffer

AU - Krause, Lars

AU - Lehm, Manuel

AU - Liman, Jan

AU - Lowens, Stephan

AU - Mpotsaris, Anastasios

AU - Papanagiotou, Panagiotis

AU - Petersen, Martina

AU - Petzold, Gabor C

AU - Pfeilschifter, Waltraud

AU - Psychogios, Marios-Nikos

AU - Reich, Arno

AU - von Rennenberg, Regina

AU - Röther, Joachim

AU - Schäfer, Jan-Hendrik

AU - Siebert, Eberhard

AU - Siedow, Andreas

AU - Solymosi, Laszlo

AU - Thonke, Sven

AU - Wagner, Marlies

AU - Wunderlich, Silke

AU - Zweynert, Sarah

AU - Nolte, Christian H

AU - Gerloff, Christian

AU - Thomalla, Götz

AU - Dichgans, Martin

AU - Fiehler, Jens

PY - 2019/9

Y1 - 2019/9

N2 - Background and Purpose- Endovascular treatment for large vessel occlusion in ischemic stroke has proven to be effective in large clinical trials. We aimed to provide real-world estimates of endovascular treatment reperfusion rates and functional outcome on a countrywide scale. Methods- Two thousand seven hundred ninety-four patients with large vessel occlusion were included into an investigator-initiated, industry-independent, prospective registry in 25 sites in Germany between June 2015 and April 2018. The primary outcome was the score on the modified Rankin Scale ranging from zero (no symptoms) to 6 (death) at 3 months. Secondary analyses included the prediction of a good outcome (modified Rankin Scale, 0-2). Dichotomized analyses of predictors were performed using logistic regression adjusted for potential confounders. Results- Median age was 75 years (interquartile range, 64-82); median National Institutes of Health Stroke Scale score was 15 (interquartile range, 10-19). Vessel occlusion was in the anterior circulation in 2265 patients (88%) and in the posterior circulation in 303 patients (12%). Intravenous alteplase before endovascular treatment was given in 1457 patients (56%). Successful reperfusion was achieved in 2143 subjects (83%). At 3 months, 854 patients (37%) showed a good outcome; mortality was 29%. There was no difference between anterior and posterior circulation occlusions (P=0.27). Significant predictors for a good outcome were younger age (odds ratio [OR], 1.06; 95% CI, 1.05-1.07), no interhospital transfer (OR, 1.39; 95% CI, 1.03-1.88), lower stroke severity (OR, 1.10; 95% CI, 1.08-1.13), smaller infarct size (OR, 1.26; 95% CI, 1.15-1.39), alteplase use (OR, 1.49; 95% CI, 1.08-2.06), and reperfusion success (OR, 1.69; 95% CI, 1.45-1.96). Conclusions- High rates of favorable outcome can be achieved on a countrywide scale by endovascular treatment. Mortality appears to be greater in the daily routine than otherwise reported by authors of large randomized trials. There were no outcome differences between the anterior and posterior circulation. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT03356392.

AB - Background and Purpose- Endovascular treatment for large vessel occlusion in ischemic stroke has proven to be effective in large clinical trials. We aimed to provide real-world estimates of endovascular treatment reperfusion rates and functional outcome on a countrywide scale. Methods- Two thousand seven hundred ninety-four patients with large vessel occlusion were included into an investigator-initiated, industry-independent, prospective registry in 25 sites in Germany between June 2015 and April 2018. The primary outcome was the score on the modified Rankin Scale ranging from zero (no symptoms) to 6 (death) at 3 months. Secondary analyses included the prediction of a good outcome (modified Rankin Scale, 0-2). Dichotomized analyses of predictors were performed using logistic regression adjusted for potential confounders. Results- Median age was 75 years (interquartile range, 64-82); median National Institutes of Health Stroke Scale score was 15 (interquartile range, 10-19). Vessel occlusion was in the anterior circulation in 2265 patients (88%) and in the posterior circulation in 303 patients (12%). Intravenous alteplase before endovascular treatment was given in 1457 patients (56%). Successful reperfusion was achieved in 2143 subjects (83%). At 3 months, 854 patients (37%) showed a good outcome; mortality was 29%. There was no difference between anterior and posterior circulation occlusions (P=0.27). Significant predictors for a good outcome were younger age (odds ratio [OR], 1.06; 95% CI, 1.05-1.07), no interhospital transfer (OR, 1.39; 95% CI, 1.03-1.88), lower stroke severity (OR, 1.10; 95% CI, 1.08-1.13), smaller infarct size (OR, 1.26; 95% CI, 1.15-1.39), alteplase use (OR, 1.49; 95% CI, 1.08-2.06), and reperfusion success (OR, 1.69; 95% CI, 1.45-1.96). Conclusions- High rates of favorable outcome can be achieved on a countrywide scale by endovascular treatment. Mortality appears to be greater in the daily routine than otherwise reported by authors of large randomized trials. There were no outcome differences between the anterior and posterior circulation. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT03356392.

U2 - 10.1161/STROKEAHA.119.026005

DO - 10.1161/STROKEAHA.119.026005

M3 - SCORING: Journal article

C2 - 31337298

VL - 50

SP - 2500

EP - 2506

JO - STROKE

JF - STROKE

SN - 0039-2499

IS - 9

ER -