Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
Peninsula Applied Research Collaboration (PenARC), University of Exeter, Exeter, Devon, UK.
Eur Stroke J. 2024 Sep;9(3):566-574. doi: 10.1177/23969873241232820. Epub 2024 Feb 17.
To support decisions about thrombectomy provision, we have previously estimated the annual UK population eligible for treatment as ∼10% of stroke admissions. Since then, eight further randomised trials that could alter the eligibility rate have reported in 2021-23. We updated our estimates of the eligible population from these trials and other recent studies.
An updated decision tree describing the EVT eligible population for UK stroke admissions was produced. Decision criteria were derived from the highest level of evidence available. For nodes where no specific RCT data existed, evidence was obtained from the latest systematic review(s) or the highest quality observational data.
We estimate that 15,420 (approximately 15%) of admitted UK stroke patients are now eligible for thrombectomy, or 14,930 if advanced brain imaging using MRI/CT perfusion or collateral assessment were used in all patients. This is a 54% increase in our previous estimate in 2021. Over 50% of LAO strokes are now potentially eligible for thrombectomy. The increase in eligibility is principally due to a much larger cohort of later presenting and/or larger ischaemic core patients.
Most previously independent LAO stroke patients presenting within 24 h, even in the presence of a large ischaemic core on initial non-contrast CT, should be considered for thrombectomy with use of advanced brain imaging in those presenting beyond 12 h to identify salvageable penumbral brain tissue. Treatment in most patients remains critically time-dependent and our estimates should be interpreted with this in mind.
为了支持关于取栓治疗提供的决策，我们之前估计，英国每年有 10%的卒中入院患者符合治疗条件。此后，2021 年至 2023 年期间，又有八项可能改变入选率的随机对照试验报告。我们根据这些试验和其他最近的研究更新了对符合入选条件的人群的估计。
我们制作了一个更新的决策树，描述了英国卒中入院患者中接受 EVT 的入选人群。决策标准源自现有最高证据级别。对于没有具体 RCT 数据的节点，从最新的系统评价或最高质量的观察性数据中获取证据。
我们估计，现在有 15420 名（约 15%）英国卒中入院患者符合取栓治疗的条件，如果所有患者都使用 MRI/CT 灌注或侧支循环评估等高级脑成像，则有 14930 名患者符合条件。这比我们 2021 年的最新估计增加了 54%。现在，超过 50%的 LAO 卒中患者可能有资格接受取栓治疗。入选标准的放宽主要是由于更大比例的较晚出现和/或更大的缺血核心患者。
大多数以前独立的 LAO 卒中患者在 24 小时内出现，即使在初始非对比 CT 上存在较大的缺血核心，在 12 小时后出现的患者应使用高级脑成像来识别可挽救的缺血半暗带脑组织，考虑进行取栓治疗。大多数患者的治疗仍然严重依赖时间，因此在解释我们的估计时应考虑到这一点。
