Functional Outcome Following Stroke Thrombectomy in Clinical Practice

Abstract

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.

How to Set up a Thrombectomy Service

“…At the same time, when comparing the St. Petersburg CSC data with real-world data from other practicing health institutions, the differences are not so significant. According to the German Stroke Registry [4] 28.5% patients died and 36.7% had good functional outcomes after ET in the carotid artery system after 90 days, which is close to our data. The outcomes differ from the results of randomized trials in other publications as well [5] and in a senior age group in particular [6].…”

Early repatriation post-thrombectomy: a model of care which maximises the capacity of a stroke network to treat patients with large vessel ischaemic stroke

“…Wollenweber et al evaluated more than 2000 patients in the German Stroke Registry from 25 sites. For anterior circulation patients only, they reported a mortality rate of 29%, with good clinical outcome in 37% of cases 16. The NASA and TRACK registries evaluated real-world stent-retriever thrombectomy for AIS for those presenting within and beyond 6 hours of onset and considered good outcomes and mortality rates separately depending on symptom onset time.…”

Adjustment of Stent Retriever Length to Clot Extent Affects First-Pass Reperfusion in Endovascular Treatment of Acute Ischemic Stroke

“…It might contribute at least in part in differences regarding good clinical outcome between groups and indicates that periprocedural SAH might be associated with an impaired rate of favorable clinical outcome after 90 days. Additionally, there are various factors known to impact on clinical outcome irrespective of reperfusion, which should be considered: age, baseline NIHSS, time interval from onset to reperfusion, infarct size on pretreatment imaging, and the presence of good collaterals [9, 20, 21]. Therefore, the results should be interpreted with caution.…”