Hyrenbach Sonja, Rode Susanne, Schabet Martin, Daffertshofer Michael, Schoser Karin, Neumaier Stephan, Ringleb Peter A
Stroke Working Group, Office for Quality Assurance in Hospitals (QiG BW), Stuttgart, Germany.
Department of Neurology, Ruprecht Karls University Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Neurol Res Pract. 2023 Dec 21;5(1):67. doi: 10.1186/s42466-023-00287-z.
Endovascular stroke treatment (EST) has become the standard treatment for patients with stroke due to large vessel occlusion, especially in earlier time windows. Only few data from population-based registries on effectiveness of EST have been published.
Baden-Wuerttemberg is the third largest state in Germany in terms of area and population and has a structured stroke concept since 1998 which includes mandatory collection of quality assurance data. In 2018 and 2019, 3820 of 39,168 ischemic stroke patients (9.8%) were treated by EST (age median 78 y, NIHSS median 14). We analyzed the clinical outcome of these patients determined with the modified Rankin Scale (mRS) at discharge from the hospital or with the initiation of palliative therapy using logistic regression analysis with adjustment for the mRS at admission, additive IVT, age, and NIHSS.
The probability of an excellent clinical outcome (mRS 0 or 1 at discharge) and for a good clinical outcome (mRS 0-2) were significantly higher in EST-patients (odds-ratio (OR) 1.27; 95% confidence interval (95% CI) 1.13-1.43, and OR of 1.15 (95% CI 1.04-1.28). Also, the regression model showed an advantage for EST-patients with less frequent 'decision for palliative care' (OR 0.87; 95% CI 0.78-0.98). Sensitivity analysis adjusting for intracranial vessel occlusion as further factor showed similar results.
Our data suggest that EST can be of benefit also for an area-wide unselected stroke population, in a large German federal state with sometimes long distance to the next thrombectomy center.
血管内卒中治疗（EST）已成为因大血管闭塞导致卒中患者的标准治疗方法，尤其是在更早的时间窗内。基于人群的登记处关于EST有效性的资料仅有少量发表。
巴登-符腾堡州是德国面积和人口第三大的州，自1998年起就有结构化的卒中概念，其中包括强制性收集质量保证数据。在2018年和2019年，39168例缺血性卒中患者中有3820例（9.8%）接受了EST治疗（年龄中位数78岁，美国国立卫生研究院卒中量表（NIHSS）中位数14）。我们使用逻辑回归分析，对入院时的改良Rankin量表（mRS）、附加静脉溶栓治疗、年龄和NIHSS进行调整，分析了这些患者在出院时或开始姑息治疗时用改良Rankin量表确定的临床结局。
EST治疗的患者获得良好临床结局（出院时mRS为0或1）和较好临床结局（mRS为0 - 2）的概率显著更高（优势比（OR）为1.27；95%置信区间（95%CI）为1.13 - 1.43，以及OR为1.15（95%CI为1.04 - 1.28））。此外，回归模型显示EST治疗的患者“决定姑息治疗”的频率较低具有优势（OR为0.87；95%CI为0.78 - 0.98）。将颅内血管闭塞作为进一步因素进行调整的敏感性分析显示了相似的结果。
我们的数据表明，在德国一个面积较大且有时距离下一个血栓切除术中心较远的联邦州，对于未经过选择的全区域卒中人群，EST可能有益。
