Improving the Clinical Outcome in Stroke Patients Receiving Thrombolytic or Endovascular Treatment in Korea: from the SECRET Study

Heo, Ji Hoe; Yoo, Joonsang; Park, Hyungjong; Kim, Byung Moon; Bang, Oh Young; Kim, Hyeon Chang; Han, Euna; Kim, Dong Joon; Heo, JoonNyung; Kim, Minyoung; Choi, Jin Kyo; Lee, Ki Young; Lee, Hye Sun; Shin, Dong Hoon; Choi, Hye Yeon; Sohn, Sung Il; Hong, Jeong Ho; Baek, Jang Hyun; Kim, Gyu Sik; Seo, Woo Keun; Chung, Jong Won; Kim, Seo Hyun; Song, Tae Jin; Han, Sang Won; Park, Joong Hyun; Kim, Jinkwon; Jung, Yo Han; Cho, Han Jin; Ahn, Seong Hwan; Lee, Sung Ik; Seo, Kwon Duk; Nam, Hyo Suk

doi:10.3390/jcm9030717

Cited by 9 publications

(12 citation statements)

References 36 publications

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“…Our study included patients from the Selection Criteria in Endovascular Thrombectomy and Thrombolytic therapy (SECRET) registry (Clinicaltrials.gov NCT02964052). The selection criteria and the definition of included variables in this registry have been published [ 14 ]. In brief, the SECRET registry is a nationwide, multicenter registry that included patients undergoing reperfusion therapy such as EVT [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Association between CHADS2, CHA2DS2-VASc, ATRIA, and Essen Stroke Risk Scores and Unsuccessful Recanalization after Endovascular Thrombectomy in Acute Ischemic Stroke Patients

Kim

Park

Yoo

et al. 2022

JCM

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Background: The CHADS2, CHA2DS2-VASc, ATRIA, and Essen scores have been developed for predicting vascular outcomes in stroke patients. We investigated the association between these stroke risk scores and unsuccessful recanalization after endovascular thrombectomy (EVT). Methods: From the nationwide multicenter registry (Selection Criteria in Endovascular Thrombectomy and Thrombolytic therapy (SECRET)) (Clinicaltrials.gov NCT02964052), we consecutively included 501 patients who underwent EVT. We identified pre-admission stroke risk scores in each included patient. Results: Among 501 patients who underwent EVT, 410 (81.8%) patients achieved successful recanalization (mTICI ≥ 2b). Adjusting for body mass index and p < 0.1 in univariable analysis revealed the association between all stroke risk scores and unsuccessful recanalization (CHADS2 score: odds ratio (OR) 1.551, 95% confidence interval (CI) 1.198–2.009, p = 0.001; CHA2DS2VASc score: OR 1.269, 95% CI 1.080–1.492, p = 0.004; ATRIA score: OR 1.089, 95% CI 1.011–1.174, p = 0.024; and Essen score: OR 1.469, 95% CI 1.167–1.849, p = 0.001). The CHADS2 score had the highest AUC value and differed significantly only from the Essen score (AUC of CHADS2 score; 0.618, 95% CI 0.554–0.681). Conclusion: All stroke risk scores were associated with unsuccessful recanalization after EVT. Our study suggests that these stroke risk scores could be used to predict recanalization in stroke patients undergoing EVT.

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Section: Methodsmentioning

confidence: 99%

Association between CHADS2, CHA2DS2-VASc, ATRIA, and Essen Stroke Risk Scores and Unsuccessful Recanalization after Endovascular Thrombectomy in Acute Ischemic Stroke Patients

Kim

Park

Yoo

et al. 2022

JCM

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“…For the validation cohort, we used data from the Selection Criteria in Endovascular Thrombectomy and Thrombolytic Therapy (SECRET) registry (Clinicaltrials.gov: NCT02964052). 17 The SECRET registry is a nationwide multicenter registry for exploring the selection criteria for patients who would benefit from reperfusion therapies. This study included 1,026 patients who 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization.…”

Section: Study Populationmentioning

confidence: 99%

Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion

et al. 2021

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Background and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion.Methods Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization.Results Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032).Conclusions The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

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“…The SMART-EST was the successor to the nationwide multicenter registry project [SElection CRiteria in Endovascular Thrombectomy and thrombolytic therapy registry (clinicaltrials.gov NCT02964052)]. 4 Written informed consent was obtained from patients or their next of kin for inclusion in the registry. The use of the registry was approved by the Institutional Review Board of each participating hospital (4-2019-0486, KBSMC 2019-11-013-001, DSMC 2019-09-011, NHIMC 2019-09-013-003, .…”

Section: Patientsmentioning

confidence: 99%

Care Process of Recanalization Therapy for Acute Stroke during the COVID-19 Outbreak in South Korea

et al. 2021

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Background and Purpose We aimed to determine whether the care process and outcomes in patients with acute stroke who received recanalization therapy changed during the outbreak of coronavirus disease 2019 (COVID-19) in South Korea. Methods We used data from a prospective multicenter reperfusion therapy registry to compare the care process—including the time from symptom onset to treatment, number of treated patients, and discharge disposition—and treatment outcomes between before and during the COVID-19 outbreak in South Korea. Results Upon the COVID-19 outbreak in South Korea, the number of patients receiving endovascular treatment to decrease temporarily but considerably. The use of emergency medical services by stroke patients increased from 91.5% before to 100.0% during the COVID-19 outbreak ( p =0.025), as did the median time from symptom onset to hospital visit [median (interquartile range), 91.0 minutes (39.8–277.0) vs. 176.0 minutes (56.0–391.5), p =0.029]. Furthermore, more functionally dependent patients with disabilities were discharged home (59.5% vs. 26.1%, p =0.020) rather than staying in a regional or rehabilitation hospital. In contrast, there were no COVID-19-related changes in the times from the hospital visit to brain imaging and treatment or in the functional outcome, successful recanalization rate, or rate of symptomatic intracerebral hemorrhage. Conclusions These findings suggest that a prehospital delay occurred during the COVID-19 outbreak, and that patients with acute stroke might have been reluctant to visit and stay in hospitals. Our findings indicate that attention should be paid to prehospital care and the behavior of patients with acute stroke during the COVID-19 outbreak.

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Improving the Clinical Outcome in Stroke Patients Receiving Thrombolytic or Endovascular Treatment in Korea: from the SECRET Study

Cited by 9 publications

References 36 publications

Association between CHADS2, CHA2DS2-VASc, ATRIA, and Essen Stroke Risk Scores and Unsuccessful Recanalization after Endovascular Thrombectomy in Acute Ischemic Stroke Patients

Association between CHADS2, CHA2DS2-VASc, ATRIA, and Essen Stroke Risk Scores and Unsuccessful Recanalization after Endovascular Thrombectomy in Acute Ischemic Stroke Patients

Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion

Care Process of Recanalization Therapy for Acute Stroke during the COVID-19 Outbreak in South Korea

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