Higher Annual Operator Volume Is Associated With Better Reperfusion Rates in Stroke Patients Treated by Mechanical Thrombectomy The ETIS Registry

被引：33

作者：

El Nawar, Rody ^{[1
,2
,3
]}

Lapergue, Bertrand ^{[4
,5
,6
,7
]}

Piotin, Michel ^{[8
]}

Gory, Benjamin ^{[9
,10
,11
]}

Blanc, Raphael ^{[8
]}

Consoli, Arturo ^{[12
]}

Rodesch, Georges ^{[12
]}

Mazighi, Mikael ^{[13
,14
]}

Bourdain, Frederic ^{[4
,5
]}

Kyheng, Maeva ^{[15
]}

Labreuche, Julien ^{[15
]}

Pico, Fernando ^{[1
,2
,6
,7
,14
]}

Redjem, Hocine

Escalard, Simon

Desilles, Jean-Philippe

Ciccio, Gabriele

Smajda, Stanislas

Fahed, Robert

Obadia, Michael

Sabben, Candice

Corabianu, Ovide

de Broucker, Thomas

Smadja, Didier

Alamowitch, Sonia

Ille, Olivier

Manchon, Eric

Garcia, Pierre-Yves

Taylor, Guillaume

Ben Maacha, Malek

Decroix, Jean-Pierre

Wang, Adrien

Evrard, Serge

Tchikviladze, Maya

Coskun, Oguzhan

Di Maria, Federico

Leguen, Morgan

Tisserand, Marie

Rakotoharinandrasana, Haja

Tassan, Philippe

Poll, Roxanna

Labeyrie, Paul Emile

Riva, Roberto

Turjman, Francis

Nighoghossian, Norbert

Derex, Laurent

Cho, Tae-Hee

Mechtouff, Laura

Lukaszewicz, Anne-Claire

Philippeau, Frederic

Cakmak, Serkan

机构：

[1] Ctr Hosp Versailles, Dept Neurol, Versailles, France

[2] Ctr Hosp Versailles, Stroke Ctr, Versailles, France

[3] Lebanese Amer Univ, Gilbert & Rose Marie Chagoury Sch Med, Beirut, Lebanon

[4] Hosp Foch, Dept Neurol, Suresnes, France

[5] Hosp Foch, Stroke Ctr, Suresnes, France

[6] Versailles Saint Quentin Yvelines, Versailles, France

[7] Paris Saclay Univ, 177 Rue Versailles, F-78150 Versailles, France

[8] Rothschild Fdn, Dept Intervent Neuroradiol, Paris, France

[9] Hospices Civils Lyon, Dept Intervent Neuroradiol, Lyon, France

[10] Univ Hosp Nancy, Dept Diagnost & Therapeut Neuroradiol, Nancy, France

[11] Univ Lorraine, INSERM, IADI, U1254, Nancy, France

[12] Hosp Foch, Dept Diagnost & Intervent Neuroradiol, Suresnes, France

[13] Paris Denis Diderot Univ, Paris, France

[14] INSERM, LVTS, F-1148 Paris, France

[15] Lille Univ, CHU Lille, EA 2694 Sante Publ Epidemiol & Qualite Soin, Lille, France

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2019年 / 12卷 / 04期

关键词：

acute ischemic stroke; ETIS register; mechanical thrombectomy; operator volume; STENT-RETRIEVER THROMBECTOMY; INTRAARTERIAL TREATMENT; ENDOVASCULAR TREATMENT; ISCHEMIC-STROKE; EXPERIENCE; OUTCOMES; TRIAL; REVASCULARIZATION; GUIDELINES;

D O I：

10.1016/j.jcin.2018.12.007

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES The aim of this study was to determine whether individual operator characteristics have an impact on reperfusion and procedural complication rates. BACKGROUND Mechanical thrombectomy (MT) is a Level IA treatment in acute ischemic stroke (AIS) patients. The operator's effect has been found to be an independent predictor for clinical outcome and technical performance in interventional cardiology. METHODS From the ETIS (Endovascular Treatment in Ischemic Stroke) study, a prospective, multicenter, observational real-world MT registry, the authors included all AIS patients consecutively treated by MT between January 2012 and March 2017 in 3 high-volume comprehensive stroke centers by 19 operators. We assessed the effect of individual operator characteristics on successful reperfusion, defined as modified Thrombolysis In Cerebral Infarction 2b/3 at the end of MT, and procedural complications using multivariable hierarchical logistic regression models. RESULTS A total of 1,541 patients with anterior and posterior AIS were enrolled (mean age 67 years; median NIHSS 16). There was a significant operator effect on successful reperfusion, with an intraclass correlation coefficient of 0.036 (p = 0.046), but not on complications (intraclass correlation coefficient = 0). There was a dose-response relationship between annual operator volume and successful reperfusion rate (p = 0.003) with an adjusted odds ratio for successful reperfusion equal to 2.52 (95% confidence interval: 1.37 to 4.64) for patients treated by an operator with an annual volume >= 40 MT/year compared with those treated by an operator with <14 MT/year (first tertile). Nevertheless, this result did not translate to better clinical outcomes. CONCLUSIONS Our data suggest that operator volume of MT/year has a positive impact on successful reperfusion in AIS patients, but not on clinical outcomes nor on complication rates. Further studies are warranted to investigate threshold procedure numbers associated with better outcomes. (J Am Coll Cardiol Intv 2019;12:385-91) (c) 2019 by the American College of Cardiology Foundation.

引用

页码：385 / 391

页数：7

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