Department of Interventional Radiology, Tower Health, Reading Hospital, West Reading, Pennsylvania.
PIH Health, Whittier, California.
J Vasc Interv Radiol. 2022 Jun;33(6):619-626.e1. doi: 10.1016/j.jvir.2021.11.018. Epub 2022 Feb 9.
To test the hypothesis that interventional radiologists (IRs) and neurointerventional (NI) physicians have similar outcomes of endovascular stroke thrombectomy (EVT), which could be used to improve the availability of thrombectomy.
Eight hospitals providing EVT performed by IRs and NI physicians at the same institution submitted sequential retrospective data limited to the era of modern devices. Good clinical outcomes (a 90-day modified Rankin score [mRS] of 0-2) and technically successful revascularization (a modified thrombolysis in cerebral infarction score of ≥2b) were compared between the specialties after adjusting for treating hospital, patient age, stroke severity, Alberta stroke program early computed tomography score, time from symptom onset to door, and clot location. Propensity score matching was used to compare the outcomes. A total of 1,009 patients were evaluated (622 treated by IRs and 387 treated by NI physicians).
The median time from stroke onset to puncture was 245 versus 253 minutes (P = .49), the technically successful revascularization rate was 81.8% versus 82.4% (P = .81), and the good clinical outcome rate was 45.5% versus 50.1% (P = .16). After adjusting, the physician specialty was not a significant predictor of good clinical outcomes (odds ratio, 1.028; 95% confidence interval, 0.760-1.390; P = .86). After matching, an mRS of 0-2 was present in 47.7% of IR treated patients and 51.1% of NI treated patients (P = .366).
There were no significant differences in the successful revascularization rate and good clinical outcomes between IRs and NI physicians. The outcomes of EVT performed by IRs were similar to those of EVT performed by NI physicians, as determined using previously published trials and registries. This may be useful for addressing coverage and access to stroke interventions.
检验介入放射学家（IR）和神经介入（NI）医生在血管内卒中介入治疗（EVT）中具有相似结果的假设，这可能有助于提高血栓切除术的可用性。
8 家在同一机构同时提供由 IR 和 NI 医生进行的 EVT 的医院提交了限定在现代设备时代的连续回顾性数据。在调整治疗医院、患者年龄、卒中严重程度、阿尔伯塔卒中项目早期计算机断层扫描评分、从症状发作到门的时间和血栓位置后，比较了两种专业的良好临床结局（90 天改良 Rankin 评分[ mRS ]为 0-2）和技术上成功的再血管化（改良脑梗死溶栓评分≥2b）。使用倾向评分匹配比较结局。共评估了 1009 例患者（622 例由 IR 治疗，387 例由 NI 医生治疗）。
卒中发作至穿刺的中位数时间分别为 245 分钟与 253 分钟（P=0.49），技术上成功的再血管化率分别为 81.8%与 82.4%（P=0.81），良好的临床结局率分别为 45.5%与 50.1%（P=0.16）。调整后，医生专业并不是良好临床结局的显著预测因素（优势比，1.028；95%置信区间，0.760-1.390；P=0.86）。匹配后，47.7%的 IR 治疗患者和 51.1%的 NI 治疗患者 mRS 为 0-2（P=0.366）。
IR 和 NI 医生的再血管化成功率和良好临床结局之间没有显著差异。IR 进行的 EVT 结果与使用先前发表的试验和登记处确定的 EVT 结果相似。这可能有助于解决卒中干预措施的覆盖范围和可及性问题。
