Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry

被引：30

作者：

Compagne, Kars C. J. ^{[1
,2
]}

Kappelhof, Manon ^{[3
]}

Hinsenveld, Wouter H. ^{[5
]}

Brouwer, Josje ^{[4
]}

Goldhoorn, Robert-Jan B. ^{[5
]}

Uyttenboogaart, Maarten ^{[7
]}

Bokkers, Reinoud P. H. ^{[8
]}

Schonewille, Wouter J. ^{[9
]}

Martens, Jasper M. ^{[11
]}

Hofmeijer, Jeannette ^{[12
]}

van der Worp, H. Bart ^{[13
]}

Lo, Rob T. H. ^{[14
]}

Keizer, Koos ^{[15
]}

Yo, Lonneke S. F. ^{[16
]}

Nijeholt, Geert J. Lycklama A. ^{[17
]}

den Hertog, Heleen M. ^{[18
,19
]}

Sturm, Emiel J. C. ^{[21
]}

Brouwers, Paul J. A. M. ^{[22
]}

van Walderveen, Marianne A. A. ^{[23
]}

Wermer, Marieke J. H. ^{[24
]}

de Bruijn, Sebastiaan F. ^{[25
]}

van Dijk, Lukas C. ^{[26
]}

Boogaarts, Hieronymus D. ^{[32
]}

van Dijk, Ewout J. ^{[33
]}

van Tuijl, Julia H.

Peluso, Jo P. P. ^{[28
]}

de Kort, Paul L. M. ^{[27
]}

van Hasselt, Boudewijn A. A. M. ^{[20
]}

Fransen, Puck S. ^{[18
,19
]}

Schreuder, Tobien H. C. M. L. ^{[29
]}

Heijboer, Roel J. J. ^{[30
]}

Jenniskens, Sjoerd F. M. ^{[31
]}

Sprengers, Marieke E. S. ^{[3
]}

Ghariq, Elias ^{[17
]}

van den Wijngaard, Ido R.

Roosendaal, Stefan D. ^{[3
]}

Meijer, Anton F. J. A. ^{[31
]}

Beenen, Ludo F. M. ^{[3
]}

Postma, Alida A. ^{[6
]}

van den Berg, Rene ^{[3
]}

Yoo, Albert J. ^{[34
]}

van Doormaal, Pieter Jan ^{[1
]}

van Proosdij, Marc P. ^{[35
]}

Krietemeijer, Menno G. M. ^{[16
]}

Gerrits, Dick G. ^{[21
]}

Hammer, Sebastiaan

Vos, Jan Albert ^{[10
]}

Boiten, Jelis

Coutinho, Jonathan M. ^{[4
]}

Emmer, Bart J. ^{[3
]}

机构：

[1] Univ Med Ctr, Erasmus MC, Dept Radiol & Nucl Med, Doctor Molewaterpl 40, NL-3015 GD Rotterdam, Netherlands

[2] Univ Med Ctr, Dept Neurol, Erasmus MC, Rotterdam, Netherlands

[3] Univ Amsterdam, Dept Radiol & Nucl Med, Amsterdam UMC, Amsterdam, Netherlands

[4] Univ Amsterdam, Amsterdam UMC, Dept Neurol, Amsterdam, Netherlands

[5] Maastricht Univ Med Ctr, Dept Neurol, Sch Cardiovasc Dis CARIM, Sch Mental Hlth & Sci, Maastricht, Netherlands

[6] Maastricht Univ Med Ctr, Sch Mental Hlth & Sci, Sch Cardiovasc Dis CARIM, Dept Radiol & Nucl Med, Maastricht, Netherlands

[7] Univ Med Ctr Groningen, Dept Neurol, Groningen, Netherlands

[8] Univ Med Ctr Groningen, Dept Radiol, Groningen, Netherlands

[9] St Antonius Hosp, Dept Neurol, Nieuwegein, Netherlands

[10] St Antonius Hosp, Dept Radiol, Nieuwegein, Netherlands

[11] Rijnstate Hosp, Dept Radiol, Arnhem, Netherlands

[12] Rijnstate Hosp, Dept Neurol, Arnhem, Netherlands

[13] Univ Med Ctr Utrecht, Brain Ctr, Dept Neurol & Neurosurg, Utrecht, Netherlands

[14] Univ Med Ctr Utrecht, Dept Radiol, Utrecht, Netherlands

[15] Catharina Hosp, Dept Neurol, Eindhoven, Netherlands

[16] Catharina Hosp, Dept Radiol, Eindhoven, Netherlands

[17] Haaglanden Med Ctr, Dept Radiol, The Hague, Netherlands

[18] Haaglanden Med Ctr, Dept Neurol, The Hague, Netherlands

[19] Isala Klin, Dept Neurol, Zwolle, Netherlands

[20] Isela Klinieken, Dept Radiol, Zwolle, Netherlands

[21] Med Spectrum Twente, Dept Radiol, Enschede, Netherlands

[22] Med Spectrum Twente, Dept Neurol, Enschede, Netherlands

[23] Leiden Univ Med Ctr, Dept Radiol, Leiden, Netherlands

[24] Leiden Univ Med Ctr, Dept Neurol, Leiden, Netherlands

[25] HAGA Hosp, Dept Neurol, The Hague, Netherlands

[26] HAGA Hosp, Dept Radiol, The Hague, Netherlands

[27] Sint Elisabeth Hosp, Dept Neurol, Willemstad, Netherlands

[28] Sint Elisabeth Hosp, Dept Radiol, Willemstad, Netherlands

[29] Dept Neurol, Zuyderland, Netherlands

[30] Dept Radiol, Zuyderland, Netherlands

[31] Radboud Univ Nijmegen Med Ctr, Dept Radiol, Nijmegen, Netherlands

[32] Radboud Univ Nijmegen Med Ctr, Dept Neurosurg, Nijmegen, Netherlands

[33] Radboud Univ Nijmegen Med Ctr, Dept Neurol, Nijmegen, Netherlands

[34] Texas Stroke Inst, Dept Radiol, Plano, TX USA

[35] Noordwest Ziekenhuisgrp, Dept Radiol, Alkmaar, Netherlands

来源：

STROKE | 2022年 / 53卷 / 06期

关键词：

groin odds; ratio; puncture; registry; reperfusion; SYSTEMATIC EVALUATION; THROMBECTOMY; GUIDELINES; REPERFUSION; RELIABILITY; MANAGEMENT; IMPUTATION; OUTCOMES; SOCIETY; SCALE;

D O I：

10.1161/STROKEAHA.121.034919

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: 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. Methods: 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). Results: 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; PP<0.001, respectively). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 66%; P<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. Conclusions: 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.

引用

页码：1863 / 1872

页数：10

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