Comparative Effectiveness of Endovascular Treatment for Acute Ischemic Stroke: A Population-Based Analysis

被引：12

作者：

Zerna, Charlotte ^{[1
,2
]}

Rogers, Edwin ^{[6
]}

Rabi, Doreen M. ^{[2
,4
]}

Demchuk, Andrew M. ^{[1
,3
,5
]}

Kamal, Noreen ^{[8
]}

Mann, Balraj ^{[7
]}

Jeerakathil, Tom ^{[9
]}

Buck, Brian ^{[9
]}

Shuaib, Ashfaq ^{[9
]}

Rempel, Jeremy ^{[10
]}

Menon, Bijoy K. ^{[1
,5
]}

Goyal, Mayank ^{[1
,3
]}

Hill, Michael D. ^{[1
,2
,3
,5
]}

机构：

[1] Univ Calgary, Cumming Sch Med, Dept Clin Neurosci, Calgary, AB, Canada

[2] Univ Calgary, Cumming Sch Med, Dept Community Hlth Sci, Calgary, AB, Canada

[3] Univ Calgary, Cumming Sch Med, Dept Radiol, Calgary, AB, Canada

[4] Univ Calgary, Cumming Sch Med, Dept Med, Calgary, AB, Canada

[5] Univ Calgary, Hotchkiss Brain Inst, Calgary, AB, Canada

[6] Alberta Hlth Serv, Clin Analyt, Edmonton, AB, Canada

[7] Alberta Hlth Serv, Cardiovasc Hlth & Stroke Strateg Clin Network, Edmonton, AB, Canada

[8] Dalhousie Univ, Dept Ind Engn, Halifax, NS, Canada

[9] Univ Alberta, Dept Med, Div Neurol, Edmonton, AB, Canada

[10] Univ Alberta, Dept Radiol & Diagnost Imaging, Edmonton, AB, Canada

来源：

JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2020年 / 9卷 / 07期

关键词：

acute stroke; comparative effectiveness; ischemic stroke; thrombectomy; treatment outcome; STENT-RETRIEVER THROMBECTOMY; HOME-TIME;

D O I：

10.1161/JAHA.119.014541

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background A heterogeneous patient population receives endovascular treatment for acute ischemic stroke caused by proximal large-vessel occlusion every day. We aimed to conduct a population-based study of in the province of Alberta, Canada, to understand the effectiveness in a complete population and how the magnitude of effect differs from the artificial world of clinical trials. Methods and Results Within a 3-year period (April 2015 to March 2018), 576 patients fit the inclusion criteria of our study and constituted the group of our analysis. The medical treatment group of the (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT [Computed Tomography] to Recanalization Times) trial had 150 patients. Thus, our total sample size was 726. We captured outcomes in clinical routine using administrative data and a linked database method. Primary outcome of our study was home-time. Home-time refers to the number of days that the patient was back at premorbid living situation without increase in level of care within 90 days of index stroke event. Median age of patients was 70 years (interquartile range, 59-81 years), and 47.8% were women. Median National Institutes of Health Stroke Scale score was 17 (interquartile range, 13-20). was associated with an increased 90-day home-time by an average of 8.5 days compared with medical treatment alone using Cragg hurdle regression (P=0.009). Age and higher National Institutes of Health Stroke Scale score were associated with decreased 90-day home-time (both P<0.001). Multivariable logistic regression showed no association between and mortality at 90 days (odds ratio, 0.76; 95% CI, 0.47-1.24). Conclusions for acute ischemic stroke caused by proximal large-vessel occlusion was effective in our province-wide population-based study and results in an increase of 90-day home-time by similar to 8.5 days.

引用

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