Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China

Abstract

Background and Purpose: The benefit of endovascular treatment (EVT) for large vessel occlusion in clinical practice in developing countries like China needs to be confirmed. The aim of the study was to determine whether the benefit of EVT for acute ischemic stroke in randomized trials could be generalized to clinical practice in Chinese population. Methods: We conducted a prospective registry of EVT at 111 centers in China. Patients with acute ischemic stroke caused by imaging-confirmed intracranial large vessel occlusion and receiving EVT were included. The primary outcome was functional independence at 90 days defined as a modified Rankin Scale score of 0 to 2. Outcomes of specific subgroups in the anterior circulation were reported and logistic regression was performed to predict the primary outcome. Results: Among the 1793 enrolled patients, 1396 (77.9%) had anterior circulation large vessel occlusion (median age, 66 [56–73] years) and 397 (22.1%) had posterior circulation large vessel occlusion (median age, 64 [55–72] years). Functional independence at 90 days was reached in 45% and 44% in anterior and posterior circulation groups, respectively. For anterior circulation population, underlying intracranial atherosclerotic disease was identified in 29% of patients, with higher functional independence at 90 days (52% versus 44%; P =0.0122) than patients without intracranial atherosclerotic disease. In the anterior circulation population, after adjusting for baseline characteristics, procedure details, and early outcomes, the independent predictors for functional independence at 90 days were age <66 years (odds ratio [OR], 1.733 [95% CI, 1.213–2.476]), time from onset to puncture >6 hours (OR, 1.536 [95% CI, 1.065–2.216]), local anesthesia (OR, 2.194 [95% CI, 1.325–3.633]), final modified Thrombolysis in Cerebral Infarction 2b/3 (OR, 2.052 [95% CI, 1.085–3.878]), puncture-to-reperfusion time ≤1.5 hours (OR, 1.628 [95% CI, 1.098–2.413]), and National Institutes of Health Stroke Scale score 24 hours after the procedure <11 (OR, 9.126 [95% CI, 6.222–13.385]). Conclusions: Despite distinct characteristics in the Chinese population, favorable outcome of EVT can be achieved in clinical practice in China. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03370939.

Endovascular treatment for acute ischemic stroke in patients with versus without atrial fibrillation: a matched-control study

“…Data were extracted from ANGEL-ACT (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke), a prospective nationwide registry of 1793 consecutive patients with AIS caused by LVO undergoing EVT in 111 hospitals in China between November 2017 and March 2019. Full methods of the registry, such as inclusion/exclusion criteria and data collection standards, have been reported earlier [ 22 ]. The protocol was approved by the ethics committees of all centers, and all participants (or legal representatives) provided written informed consent.…”

Safety and Efficacy of Low-Dose Tirofiban Combined With Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischemic Stroke: A Matched-Control Analysis From a Nationwide Registry

“…All patients were enrolled from the registry of "ANGEL-ACT, " which was a nationwide, multicenter, prospective registry study conducted in China from November 2017 to March 2019. Details of the design of the ANGEL-ACT have been reported previously (16). The protocol of the ANGEL-ACT was approved by the Ethics Committee of Beijing Tiantan Hospital and all other participating centers.…”

Workflow Intervals andOutcomesof Endovascular Treatment for Acute Large-Vessel Occlusion During On- Versus Off-Hours in China The ANGEL-ACT Registry

“…The definition of off-hours was set according to statutory holidays and time nodes. The ANGEL-ACT registry contains data from 111 hospitals in 26 provinces in China 21 . These hospitals share Beijing time in Dongba District, which is the standard time in China.…”

“…ANGEL-ACT was a nationwide, prospective, observational study of 1793 consecutive adult patients with acute LVO treated with EVT at 111 hospitals from 26 provinces in China between November 2017 and March 2019 (https://www.clinicaltrials.gov; unique identifier: NCT03370939). Detailed information about the ANGEL-ACT registry can be found in a previously published article 21 . Ethics approval was granted by the ethics committees of Beijing Tiantan Hospital and all participating centers.…”

“…The Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) registry was established to evaluate the utilization and subsequent outcomes of AIS patients who received EVT and has confirmed that favorable outcomes of EVT can be achieved in clinical practice in China 21 . In this study, we analyzed prospectively collected ANGEL-ACT data to observe whether the workflow intervals and radiological/clinical outcomes were different between patients with acute LVO treated with EVT who presented during on-versus off-hours.…”