Department of Radiology and Nuclear Medicine (K.C.J.C., P.J.v.D.), Erasmus MC, University Medical Center' Rotterdam' the Netherlands.
Department of Neurology (K.C.J.C., B.R., D.W.J.D.), Erasmus MC, University Medical Center' Rotterdam' the Netherlands.
Stroke. 2022 Jun;53(6):1863-1872. doi: 10.1161/STROKEAHA.121.034919. Epub 2022 Feb 9.
We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes.
We included patients with proximal occlusions of the anterior circulation from the second and first cohorts of the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry (March 2014 to June 2016; June 2016 to November 2017, respectively). We compared workflow times and rates of successful reperfusion (defined as an extended Thrombolysis in Cerebral Infarction score of 2B-3) between cohorts and chronological quartiles (all included patients stratified in chronological quartiles of intervention dates to create equally sized groups over the study period). Multivariable ordinal logistic regression was used to assess differences in the primary outcome (ordinal modified Rankin Scale at 90 days).
Baseline characteristics were similar between cohorts (second cohort n=1692, first cohort n=1488) except for higher age, poorer collaterals, and less signs of early ischemia on computed tomography in the second cohort. Time from stroke onset to groin puncture and reperfusion were shorter in the second cohort (median 185 versus 210 minutes; <0.001 and 236 versus 270 minutes; <0.001, respectively). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 66%; <0.001). Functional outcome significantly improved (adjusted common odds ratio 1.23 [95% CI, 1.07-1.40]). This effect was attenuated by adjustment for time from onset to reperfusion (adjusted common odds ratio, 1.12 [95% CI, 0.98-1.28]) and successful reperfusion (adjusted common odds ratio, 1.13 [95% CI, 0.99-1.30]). Outcomes were consistent in the analysis per chronological quartile.
Clinical outcomes after endovascular treatment for acute ischemic stroke in routine clinical practice have improved over the past years, likely resulting from improved workflow times and higher successful reperfusion rates.
我们评估了过去 3.5 年内荷兰所有接受血管内治疗急性缺血性卒中的患者的数据，以确定治疗时间和程序成功率的全国趋势，并评估其对临床结果的影响。
我们纳入了来自 MR CLEAN（荷兰多中心急性缺血性卒中血管内治疗随机临床试验）登记处的第二和第一队列中近端前循环闭塞的患者（分别为 2014 年 3 月至 2016 年 6 月和 2016 年 6 月至 2017 年 11 月）。我们比较了两个队列和时间顺序四分位数之间的工作流程时间和再灌注成功率（定义为扩展的脑梗死溶栓评分 2B-3）（所有纳入的患者按干预日期的时间顺序四分位数分层，以在研究期间创建大小相等的组）。多变量有序逻辑回归用于评估主要结局（90 天的改良 Rankin 量表）的差异。
除了年龄较大、侧支循环较差以及在第二队列中 CT 上早期缺血的迹象较少外，两个队列的基线特征相似（第二队列 1692 例，第一队列 1488 例）。从卒中发作到股动脉穿刺和再灌注的时间在第二队列中更短（中位数 185 分钟与 210 分钟；<0.001 和 236 分钟与 270 分钟；<0.001，分别）。第二队列的再灌注成功率高于第一队列（72%比 66%；<0.001）。功能结果显著改善（调整后的共同优势比 1.23[95%置信区间，1.07-1.40]）。通过调整再灌注时间（调整后的共同优势比，1.12[95%置信区间，0.98-1.28]）和再灌注成功率（调整后的共同优势比，1.13[95%置信区间，0.99-1.30]），该效果减弱。按时间顺序四分位数进行分析的结果一致。
在常规临床实践中，血管内治疗急性缺血性卒中的临床结果在过去几年中有所改善，这可能是由于工作流程时间的改善和再灌注成功率的提高所致。
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