Functional Outcome Following Stroke Thrombectomy in Clinical Practice
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Functional Outcome Following Stroke Thrombectomy in Clinical Practice. / Wollenweber, Frank A; Tiedt, Steffen; Alegiani, Anna; Alber, Burkhard; Bangard, Christopher; Berrouschot, Jörg; Bode, Felix J; Boeckh-Behrens, Tobias; Bohner, Georg; Bormann, Albrecht; Braun, Michael; Dorn, Franziska; Eckert, Bernd; Flottmann, Fabian; Hamann, Gerhard F; Henn, Karl-Heinz; Herzberg, Moriz; Kastrup, Andreas; Kellert, Lars; Kraemer, Christoffer; Krause, Lars; Lehm, Manuel; Liman, Jan; Lowens, Stephan; Mpotsaris, Anastasios; Papanagiotou, Panagiotis; Petersen, Martina; Petzold, Gabor C; Pfeilschifter, Waltraud; Psychogios, Marios-Nikos; Reich, Arno; von Rennenberg, Regina; Röther, Joachim; Schäfer, Jan-Hendrik; Siebert, Eberhard; Siedow, Andreas; Solymosi, Laszlo; Thonke, Sven; Wagner, Marlies; Wunderlich, Silke; Zweynert, Sarah; Nolte, Christian H; Gerloff, Christian; Thomalla, Götz; Dichgans, Martin; Fiehler, Jens.
In: STROKE, Vol. 50, No. 9, 09.2019, p. 2500-2506.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -