Determining the Number of Ischemic Strokes Potentially Eligible for Endovascular Thrombectomy A Population-Based Study

被引：112

作者：

Chia, Nicholas H. ^{[1
]}

Leyden, James M. ^{[2
]}

Newbury, Jonathan ^{[3
]}

Jannes, Jim ^{[1
,3
]}

Kleinig, Timothy J. ^{[1
,2
,3
]}

机构：

[1] Royal Adelaide Hosp, Dept Neurol, Adelaide, SA 5000, Australia

[2] Lyell McEwin Hosp, Dept Neurol, Adelaide, SA, Australia

[3] Univ Adelaide, Dept Med, Adelaide, SA 5001, Australia

来源：

STROKE | 2016年 / 47卷 / 05期

基金：

英国医学研究理事会;

关键词：

brain ischemia; endovascular treatment; epidemiology; stroke; thrombectomy; TRIAL;

D O I：

10.1161/STROKEAHA.116.013165

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-Endovascular thrombectomy (ET) is standard-of-care for ischemic stroke patients with large vessel occlusion, but estimates of potentially eligible patients from population-based studies have not been published. Such data are urgently needed to rationally plan hyperacute services. Retrospective analysis determined the incidence of ET-eligible ischemic strokes in a comprehensive population-based stroke study (Adelaide, Australia 2009-2010). Methods-Stroke patients were stratified via a prespecified eligibility algorithm derived from recent ET trials comprising stroke subtype, pathogenesis, severity, premorbid modified Rankin Score, presentation delay, large vessel occlusion, and target mismatch penumbra. Recognizing centers may interpret recent ET trials either loosely or rigidly; 2 eligibility algorithms were applied: restrictive (key criteria modified Rankin Scale score 0-1, presentation delay <3.5 hours, and target mismatch penumbra) and permissive (modified Rankin Scale score 0-3 and presentation delay <5 hours). Results-In a population of 148 027 people, 318 strokes occurred in the 1-year study period (crude attack rate 215 [192-240] per 100 000 person-years). The number of ischemic strokes eligible by restrictive criteria was 17/258 (7%; 95% confidence intervals 4%-10%) and by permissive criteria, an additional 16 were identified, total 33/258 (13%; 95% confidence intervals 9%-18%). Two of 17 patients (and 6/33 permissive patients) had thrombolysis contraindications. Using the restrictive algorithm, there were 11 (95% confidence intervals 4-18) potential ET cases per 100 000 person-years or 22 (95% confidence intervals 13-31) using the permissive algorithm. Conclusions-In this cohort, approximate to 7% of ischemic strokes were potentially eligible for ET (13% with permissive criteria). In similar populations, the permissive criteria predict that <= 22 strokes per 100 000 person-years may be eligible for ET.

引用

页码：1377 / 1380

页数：4

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