Beom Joon Kim1, Moon-Ku Han1, Tai Hwan Park2, Sang-Soon Park2, Kyung Bok Lee3, Byung-Chul Lee4, Kyung-Ho Yu4, Mi Sun Oh4, Jae Kwan Cha5, Dae-Hyun Kim5, Jun Lee6, Soo Joo Lee7, Youngchai Ko7, Jong-Moo Park8, Kyusik Kang8, Yong-Jin Cho9, Keun-Sik Hong9, Joon-Tae Kim10, Jay Chol Choi11, Dong-Eog Kim12, Juneyoung Lee13, Ji Sung Lee14, Philip B Gorelick15, Byung-Woo Yoon16, Hee-Joon Bae17. 1. Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. 2. Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea. 3. Department of Neurology, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea. 4. Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea. 5. Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea. 6. Department of Neurology, Yeungnam University Medical Center, Daegu, Republic of Korea. 7. Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea. 8. Department of Neurology, Eulji General Hospital, Seoul, Republic of Korea. 9. Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea. 10. Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea. 11. Department of Neurology, Jeju National University Hospital, Jeju, Republic of Korea. 12. Department of Neurology, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea. 13. Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea. 14. Biostatistical Consulting Unit, Soonchunhyang University Medical Center, Seoul, Republic of Korea. 15. Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine & Saint Mary's Health Care at Mercy Health, Grand Rapids, Michigan. 16. Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea. 17. Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. Electronic address: braindoc@snu.ac.kr.
Abstract
BACKGROUND: Despite recent technical advances in endovascular recanalization, there is skepticism regarding its clinical effectiveness compared with intravenous thrombolysis for treating acute ischemic stroke. We aimed to delineate its effectiveness and safety and their change over time. METHODS: Using a prospective, multicenter stroke registry database, we identified 872 patients with ischemic stroke who underwent recanalization therapy with intravenous thrombolysis alone (IVT; n = 533) or endovascular recanalization with or without intravenous thrombolysis (EVT; n = 339) between April 2008 and January 2012. All subjects had National Institute of Health Stroke Scale score of 10 or more and arrived at the hospital within 4.5 hours of onset. Propensity score was used to address baseline imbalances between treatment groups, but balance adjustment was not performed for subgroup analyses. RESULTS: The primary outcome was modified Rankin Scale score of 0-2 at discharge. The year-by-year effectiveness and safety of EVT and IVT were compared. Before 2010, the primary outcome was not associated with the recanalization method. However, in 2011, EVT increased the odds of having a primary outcome compared with IVT (adjusted odds ratio [OR], 1.87; 95% confidence interval [CI], 1.08-3.23). In 2011, EVT was superior to IVT regarding the achievement of a favorable outcome at 3 months after stroke (OR, 1.99; 95% CI, 1.10-3.59). The odds of in-hospital mortality and 3-month mortality were not different over 4 years. CONCLUSIONS: There might have been a change in the effectiveness of endovascular recanalization compared with intravenous thrombolysis, but the results remain tentative until prospectively evaluated.
BACKGROUND: Despite recent technical advances in endovascular recanalization, there is skepticism regarding its clinical effectiveness compared with intravenous thrombolysis for treating acute ischemic stroke. We aimed to delineate its effectiveness and safety and their change over time. METHODS: Using a prospective, multicenter stroke registry database, we identified 872 patients with ischemic stroke who underwent recanalization therapy with intravenous thrombolysis alone (IVT; n = 533) or endovascular recanalization with or without intravenous thrombolysis (EVT; n = 339) between April 2008 and January 2012. All subjects had National Institute of Health Stroke Scale score of 10 or more and arrived at the hospital within 4.5 hours of onset. Propensity score was used to address baseline imbalances between treatment groups, but balance adjustment was not performed for subgroup analyses. RESULTS: The primary outcome was modified Rankin Scale score of 0-2 at discharge. The year-by-year effectiveness and safety of EVT and IVT were compared. Before 2010, the primary outcome was not associated with the recanalization method. However, in 2011, EVT increased the odds of having a primary outcome compared with IVT (adjusted odds ratio [OR], 1.87; 95% confidence interval [CI], 1.08-3.23). In 2011, EVT was superior to IVT regarding the achievement of a favorable outcome at 3 months after stroke (OR, 1.99; 95% CI, 1.10-3.59). The odds of in-hospital mortality and 3-month mortality were not different over 4 years. CONCLUSIONS: There might have been a change in the effectiveness of endovascular recanalization compared with intravenous thrombolysis, but the results remain tentative until prospectively evaluated.
Authors: Beom Joon Kim; Jong Won Chung; Hong Kyun Park; Jun Yup Kim; Mi Hwa Yang; Moon Ku Han; Cheolkyu Jeong; Gyojun Hwang; O Ki Kwon; Hee Joon Bae Journal: J Clin Neurol Date: 2017-01-12 Impact factor: 3.077