Division of Neuroradiology, Department of Radiology, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
Division of Neurology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
Can Assoc Radiol J. 2020 Feb;71(1):63-67. doi: 10.1177/0846537119885668. Epub 2020 Jan 22.
Endovascular thrombectomy (EVT) treatment for acute ischemic stroke is now recommended as a standard of care. However, implementing EVT in routine clinical practice poses many challenges, even in countries with advanced health-care systems. The aim of the current study is to delineate if EVT at our institution is an effective treatment for acute ischemic stroke.
All patients who underwent EVT at our institution between December 2011 and July 2017 were retrospectively assessed from our prospective registry. Clinical and imaging (including the Alberta Stroke Program Early CT [ASPECT] score, single-phase computed tomography angiography, and computed tomography perfusion) criteria were utilized to determine EVT suitability. Primary outcomes included modified Rankin score (mRS) at 90 days and recanalization determined by the modified Treatment in Cerebral Infarction score. Effectiveness was assessed by comparing our cohort with patients receiving EVT in the ESCAPE (Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke) trial.
Eighty-eight patients presented to our hospital after a median of 87 minutes last seen normal. Of these, median ASPECT score was 9. A majority (72%) also received intravenous alteplase. Successful recanalization (≥TICI 2b) was achieved in 79%. At 90 days, 48% (36/75) were functionally independent (mRS score of 0-2) and 28% (21/75) were disabled (mRS score of 3-5); 24% (18/75) died (mRS of 6) within 90 days.
An audit of our initial experience with EVT for the treatment of acute ischemic stroke in a small tertiary care center yielded similar results compared to the ESCAPE trial, which is encouraging for implementing this treatment in routine clinical practice.
急性缺血性脑卒中的血管内血栓切除术（EVT）治疗目前被推荐为一种标准的治疗方法。然而，即使在医疗保健系统先进的国家，在常规临床实践中实施 EVT 也面临许多挑战。本研究旨在探讨我们机构的 EVT 治疗急性缺血性脑卒中是否有效。
我们从前瞻性登记处回顾性评估了 2011 年 12 月至 2017 年 7 月期间在我院接受 EVT 的所有患者。临床和影像学（包括阿尔伯塔卒中项目早期 CT [ASPECT]评分、单相 CT 血管造影和 CT 灌注）标准用于确定 EVT 的适用性。主要结局包括 90 天时的改良 Rankin 评分（mRS）和改良治疗脑梗死评分确定的再通率。通过与 ESCAPE（血管内治疗小核心和近端闭塞性缺血性卒中）试验中接受 EVT 的患者进行比较来评估有效性。
88 例患者在发病后中位数 87 分钟到达我院，最后一次正常时间。其中，中位数 ASPECT 评分为 9。大多数患者（72%）还接受了静脉内阿替普酶治疗。79%的患者实现了成功再通（≥TICI 2b）。90 天时，48%（36/75）的患者功能独立（mRS 评分为 0-2），28%（21/75）的患者残疾（mRS 评分为 3-5）；24%（18/75）的患者在 90 天内死亡（mRS 评分为 6）。
对我们在一家小型三级护理中心进行 EVT 治疗急性缺血性脑卒中的初始经验进行审核后，与 ESCAPE 试验相比，结果相似，这为在常规临床实践中实施这种治疗方法提供了鼓舞。
