Andreia Carvalho1, André Cunha2, Marta Rodrigues2, Sofia Figueiredo1, Ludovina Paredes3, Tiago Gregório3, Hugo Morais4, Joaquim Pinheiro4, Vítor Tedim Cruz5, José Mário Roriz5, João Pinho6, Carla Ferreira6, Edgar Torre7, Joana Nunes2, Sérgio Castro2, Manuel Ribeiro2, Miguel Veloso1, Pedro Barros8. 1. Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Stroke Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. 2. Imagiology Department, Neuroradiology Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. 3. Stroke Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. 4. Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. 5. Neurology Department, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal. 6. Neurology Department, Hospital Escala Braga, Braga, Portugal. 7. Stroke Unit, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal. 8. Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Stroke Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. Electronic address: pedrojgbarros@gmail.com.
Abstract
BACKGROUND: Until recently, intravenous thrombolysis was the only reperfusion therapy with proven efficacy in patients with acute ischemic stroke. However, this treatment option has low recanalization rates in large-vessel occlusions. The search for additional treatments continued until 5 randomized trials (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT) revealed the superiority of mechanical thrombectomy for anterior circulation large-vessel occlusion. After 1 year of performing thrombectomy with stent retrievers in our tertiary hospital, we intended to answer the question: is it possible to achieve similar results in a "real-world" setting? METHODS: We analyzed data from our prospective observational registry, compared it with the trials aforementioned, and concluded that the answer is affirmative. RESULTS: Our study population of 77 patients, with a mean age of 68,2 years and 48,1% men, is comparable with these trials in much of selection criteria, baseline characteristics, and rate of previous intravenous thrombolysis (72,7%). Recovery of functional independence at 90 days was achieved in almost two thirds of patients, similarly to the referred trials. We devoted special emphasis on fast recanalization, keeping a simple image selection protocol (based on non-enhanced and computed tomography angiography) and not waiting for clinical response to thrombolysis in patients eligible for mechanical thrombectomy. We emphasize a successful recanalization rate of 87% and only 2,6% symptomatic intracranial hemorrhage. CONCLUSION: In summary, mechanical thrombectomy seems to be a safe and effective treatment option in a "real-world" scenario, with results similar to those of the recent randomized controlled trials.
RCT Entities:
BACKGROUND: Until recently, intravenous thrombolysis was the only reperfusion therapy with proven efficacy in patients with acute ischemic stroke. However, this treatment option has low recanalization rates in large-vessel occlusions. The search for additional treatments continued until 5 randomized trials (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT) revealed the superiority of mechanical thrombectomy for anterior circulation large-vessel occlusion. After 1 year of performing thrombectomy with stent retrievers in our tertiary hospital, we intended to answer the question: is it possible to achieve similar results in a "real-world" setting? METHODS: We analyzed data from our prospective observational registry, compared it with the trials aforementioned, and concluded that the answer is affirmative. RESULTS: Our study population of 77 patients, with a mean age of 68,2 years and 48,1% men, is comparable with these trials in much of selection criteria, baseline characteristics, and rate of previous intravenous thrombolysis (72,7%). Recovery of functional independence at 90 days was achieved in almost two thirds of patients, similarly to the referred trials. We devoted special emphasis on fast recanalization, keeping a simple image selection protocol (based on non-enhanced and computed tomography angiography) and not waiting for clinical response to thrombolysis in patients eligible for mechanical thrombectomy. We emphasize a successful recanalization rate of 87% and only 2,6% symptomatic intracranial hemorrhage. CONCLUSION: In summary, mechanical thrombectomy seems to be a safe and effective treatment option in a "real-world" scenario, with results similar to those of the recent randomized controlled trials.
Authors: Sean M Davidson; Sapna Arjun; Maryna V Basalay; Robert M Bell; Daniel I Bromage; Hans Erik Bøtker; Richard D Carr; John Cunningham; Arjun K Ghosh; Gerd Heusch; Borja Ibanez; Petra Kleinbongard; Sandrine Lecour; Helen Maddock; Michel Ovize; Malcolm Walker; Marlene Wiart; Derek M Yellon Journal: Basic Res Cardiol Date: 2018-10-11 Impact factor: 17.165