Clinical effect of successful reperfusion in patients presenting with NIHSS &lt; 8: data from the BEYOND-SWIFT registry

Kaesmacher, Johannes; Chaloulos-Iakovidis, Panagiotis; Panos, Leonidas; Mordasini, Pasquale; Heldner, Mirjam Rachel; Kurmann, Christoph; Michel, Patrik; Hajdu, Steven D.; Ribó, Marc; Requena, Manuel; Maegerlein, Christian; Friedrich, Benjamin; Costalat, Vincent; Benali, Amel; Piérot, Laurent; Gawlitza, Matthias; Schaafsma, Joanna D.; Pereira, Vítor Mendes; Gralla, Jan; Fischer, Urs

doi:10.1007/s00415-018-09172-1

Cited by 16 publications

(9 citation statements)

References 50 publications

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“…A previous survey on neurointerventionalists showed increasing aggressiveness in selecting patients for MT after publication of the 2015 trials 18. Since that time, studies have demonstrated that MT is safe with a high rate of good outcomes in patients presenting with National Institute of Health Stroke Scale score of <8 19–22. A meta-analysis of seven randomized controlled MT trials showed significantly better functional outcomes with MT compared with medical management for patients presenting with more severe infarct burden as measured by pre-procedure ASPECTS scores as low as 3–6 23.…”

Section: Discussionmentioning

confidence: 99%

Real-world effects of late window neurothrombectomy: procedure rates increase without night-time bias

Williams

Leslie‐Mazwi

Hirsch

et al. 2019

J NeuroIntervent Surg

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IntroductionWith the expansion of the interventional time window for stroke from emergent large vessel occlusion (ELVO), the rate of mechanical thrombectomy (MT) is expected to rise, potentially causing higher burnout rates and requiring hospitals to develop strategies for adequate coverage of these procedures.MethodsNeurointerventional physicians at 10 participating stroke centers prospectively recorded time requirements for all MT consultations over 30 consecutive 24-hour call periods, including both false positive consultations and MT procedures, during mid to late 2018. Consult start time, procedure start and end time, and data regarding commute to the hospital and delay in scheduled procedures were collected and compared with those from an identical prospective study performed in 2017.ResultsData were collected from a total of 300 days of call. A total of 166 procedures were performed (mean 0.55 per day), an increase from 0.32 per day in 2017. Overall mean MT direct time burden during each 24-hour call was 124 min (compared with 85 min in 2017). The percentage of consultations for thrombectomy varied based on time of day, with 87% of consults between the hours of midnight and 04:00 proceeding to thrombectomy compared with 37% between the hours of 16:00 and 20:00.ConclusionsMT procedural volumes have increased from one every 5 days in 2016 to one every 2 days in 2018. The highest percentage of consults leading to thrombectomy occur in the early morning hours after midnight. Compared with similar data from 2016 and 2017, call demands continue to escalate, representing a significant demand on neurointerventional teams.

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Section: Discussionmentioning

confidence: 99%

Real-world effects of late window neurothrombectomy: procedure rates increase without night-time bias

Williams

Leslie‐Mazwi

Hirsch

et al. 2019

J NeuroIntervent Surg

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“…Details of the BEYOND-SWIFT Registry are in the public domain (NCT03496064) and have been published previously 24. Briefly, the registry is a retrospective, multicenter, non-randomized observational study designed to investigate the safety and efficacy of a Medtronic market-released neurothrombectomy device (applied as the initial device used for interventions) in patients with acute ischemic stroke who do not fulfill treatment eligibility requirements according to the current guidelines.…”

Section: Methodsmentioning

confidence: 99%

Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation

Meinel

Kaesmacher

Chaloulos-Iakovidis

et al. 2019

J NeuroIntervent Surg

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119

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BackgroundPerforming mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based.ObjectiveTo compare patients’ outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT.MethodsIn the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms.ResultsMT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 – 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 – 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO.ConclusionsIn selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR.Trial registration numberNCT03496064

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“…Details on the registry (BEYOND-SWIFT [Registry for Evaluating Outcome of Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy]) are registered at NCT03496064 and further details were published previously. 9 Patient consent was obtained according to Good Clinical Practice or institutional review board or local or institutional policies.…”

Section: Methodsmentioning

confidence: 99%

Association of initial imaging modality and futile recanalization after thrombectomy

et al. 2020

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ObjectiveTo test the hypothesis that selection by initial imaging modality (MRI vs CT) is associated with rate of futile recanalizations (FR) after mechanical thrombectomy (MT), we assessed this association in a multicenter, retrospective observational registry (BEYOND-SWIFT, NCT03496064).MethodsIn 2011 patients (49.7% female, median age 73 [61–81]) included between 2009 and 2017, we performed univariate and multivariate analyses regarding the occurrence of FR. FR were defined as 90 days modified Rankin Scale (mRS) 4–6 despite successful recanalization in patients selected by MRI (N = 690) and CT (N = 1,321) with a sensitivity analysis considering only patients with mRS 5–6 as futile.ResultsMRI as compared to CT resulted in similar rates of subsequent MT (aOR 1.048, 95% CI 0.677–1.624). Rates of FR were as follows: 571/1,489 (38%) FR mRS 4–6 including 393/1,489 (26%) FR mRS 5–6. CT based selection was associated with increased rates of futile recanalizations compared to MRI (44% [41%–47%] vs 29% [25%–32%], p < 0.001; aOR 1.77 [95%-CI: 1.25–2.51]). These findings were robust in sensitivity analysis. MRI-selected patients had a delay of approximately 30 minutes in workflow metrics in real-world university comprehensive stroke centers. However, functional outcome and mortality were more favorable in patients selected by MRI compared to patients selected with CT.ConclusionsCT-selection for MT was associated with an increased risk of futile recanalizations as compared to MR-selection. Efforts are still needed to shorten workflow delays in MRI patients. Further research is needed to clarify the role of the initial imaging modality on FR occurrence and to develop a reliable FR prediction algorithm.

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Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry

Cited by 16 publications

References 50 publications

Real-world effects of late window neurothrombectomy: procedure rates increase without night-time bias

Real-world effects of late window neurothrombectomy: procedure rates increase without night-time bias

Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation

Association of initial imaging modality and futile recanalization after thrombectomy

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