Selection criteria for endovascular therapy for acute ischaemic stroke: Are patients missing out?

被引：1

作者：

Maingard, Julian ^{[1
,2
]}

Churilov, Leonid ^{[3
,4
]}

Mitchell, Peter ^{[5
]}

Dowling, Richard ^{[5
]}

Yan, Bernard ^{[5
]}

机构：

[1] Royal Melbourne Hosp, Melbourne Brain Ctr, Melbourne, Vic, Australia

[2] Deakin Univ, Fac Hlth, Sch Med, Waurn Ponds, Vic, Australia

[3] Florey Inst Neurosci & Mental Hlth, Melbourne, Vic, Australia

[4] Univ Melbourne, Dept Math & Stat, Melbourne, Vic, Australia

[5] Royal Melbourne Hosp, Dept Radiol, Neurointervent Serv, Melbourne, Vic, Australia

来源：

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY | 2018年 / 62卷 / 03期

关键词：

acute ischaemic stroke; selection criteria; endovascular; intra-arterial; outcomes; THROMBECTOMY; METAANALYSIS;

D O I：

10.1111/1754-9485.12700

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

IntroductionEndovascular clot retrieval (ECR) following intravenous thrombolysis is superior to intravenous thrombolysis alone for acute stroke with large vessel occlusion. However, trial selection criteria may exclude potentially salvageable patients. We investigated the impact of published selection criteria on the different proportions of patients excluded and clinical outcome. MethodsWe included patients with anterior circulation stroke treated with ECR from a single centre. Selection criteria from five trials (REVASCAT, EXTEND IA, MR CLEAN, SWIFT PRIME, ESCAPE) and American Stroke Association (ASA) guidelines were applied. We calculated the proportion of patient's ineligible for ECR according to different selection criteria. Clinical benefit and harm were quantified as the number of patients benefiting per 1 patient harmed (NB1H) for each of the 6 applied selection criteria. ResultsOne hundred and seventy-eight patients were included. Mean age was 74 (SD 14) years, 60.1% were male, median baseline NIHSS was 17 (IQR 13-21). Patients were hypothetically excluded from ECR: REVASCAT 35.4%, EXTENDA IA 86%, SWIFT PRIME 86%, MR CLEAN 2.3%, ESCAPE 93.3% and ASA 29.2%. The NB1H for included and excluded patients respectively in decreasing order of magnitude: EXTEND IA >100 vs 3, ESCAPE >100 vs 3.4, SWIFT PRIME 10 vs 3.3, REVASCAT 4.4 vs 2.9, MR CLEAN 3.7 vs >100, and ASA 3.7 vs 3.9. ConclusionWe found that criteria from MR CLEAN, ASA and REVASCAT excluded the lowest proportion of patients with comparable NB1H. We believe that these criteria would be reasonable to be utilised for ECR selection.

引用

页码：345 / 354

页数：10

共 14 条

[1] Endovascular Thrombectomy for Acute Ischemic Stroke A Meta-analysis [J].

Badhiwala, Jetan H. ;

Nassiri, Farshad ;

Alhazzani, Waleed ;

Selim, Magdy H. ;

Farrokhyar, Forough ;

Spears, Julian ;

Kulkarni, Abhaya V. ;

Singh, Sheila ;

Alqahtani, Abdulrahman ;

Rochwerg, Bram ;

Alshahrani, Mohammad ;

Murty, Naresh K. ;

Alhazzani, Adel ;

Yarascavitch, Blake ;

Reddy, Kesava ;

Zaidat, Osama O. ;

Almenawer, Saleh A. .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2015, 314 (17) :1832-1843

[2] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[3] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[4] How many stroke patients might be eligible for mechanical thrombectomy? [J].

El Tawil, Salwa ;

Cheripelli, Bharath ;

Huang, Xuya ;

Moreton, Fiona ;

Kalladka, Dheeraj ;

MacDougal, Niall J. J. ;

McVerry, Ferghal ;

Muir, Keith W. .

EUROPEAN STROKE JOURNAL, 2016, 1 (04) :264-271

[5] Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials [J].

Emberson, Jonathan ;

Lees, Kennedy R. ;

Lyden, Patrick ;

Blackwell, Lisa ;

Albers, Gregory ;

Bluhmki, Erich ;

Brott, Thomas ;

Cohen, Geoff ;

Davis, Stephen ;

Donnan, Geoffrey ;

Grotta, James ;

Howard, George ;

Kaste, Markku ;

Koga, Masatoshi ;

von Kummer, Ruediger ;

Lansberg, Maarten ;

Lindley, Richard I. ;

Murray, Gordon ;

Olivot, Jean Marc ;

Parsons, Mark ;

Tilley, Barbara ;

Toni, Danilo ;

Toyoda, Kazunori ;

Wahlgren, Nils ;

Wardlaw, Joanna ;

Whiteley, William ;

del Zoppo, Gregory J. ;

Baigent, Colin ;

Sandercock, Peter ;

Hacke, Werner .

LANCET, 2014, 384 (9958) :1929-1935

[6] Hemorrhagic transformation within 36 hours of a cerebral infarct - Relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort [J].

Fiorelli, M ;

Bastianello, S ;

von Kummer, R ;

del Zoppo, GJ ;

Larrue, V ;

Lesaffre, E ;

Ringleb, AP ;

Lorenzano, S ;

Manelfe, C ;

Bozzao, L .

STROKE, 1999, 30 (11) :2280-2284

[7] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[8] Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials [J].

Goyal, Mayank ;

Menon, Bijoy K. ;

van Zwam, Wim H. ;

Dippel, Diederik W. J. ;

Mitchell, Peter J. ;

Demchuk, Andrew M. ;

Davalos, Antoni ;

Majoie, Charles B. L. M. ;

van der Lugt, Aad ;

de Miquel, Maria A. ;

Donnan, Geoff Rey A. ;

Roos, Yvo B. W. E. M. ;

Bonafe, Alain ;

Jahan, Reza ;

Diener, Hans-Christoph ;

van den Berg, Lucie A. ;

Levy, Elad I. ;

Berkhemer, Olvert A. ;

Pereira, Vitor M. ;

Rempel, Jeremy ;

Millan, Monica ;

Davis, Stephen M. ;

Roy, Daniel ;

Thornton, John ;

San Roman, Luis ;

Ribo, Marc ;

Beumer, Debbie ;

Stouch, Bruce ;

Brown, Scott ;

Campbell, Bruce C. V. ;

van Oostenbrugge, Robert J. ;

Saver, Jeff Rey L. ;

Hill, Michael D. ;

Jovin, Tudor G. .

LANCET, 2016, 387 (10029) :1723-1731

[9] Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke [J].

Jovin, T. G. ;

Chamorro, A. ;

Cobo, E. ;

de Miquel, M. A. ;

Molina, C. A. ;

Rovira, A. ;

San Roman, L. ;

Serena, J. ;

Abilleira, S. ;

Ribo, M. ;

Millan, M. ;

Urra, X. ;

Cardona, P. ;

Lopez-Cancio, E. ;

Tomasello, A. ;

Castano, C. ;

Blasco, J. ;

Aja, L. ;

Dorado, L. ;

Quesada, H. ;

Rubiera, M. ;

Hernandez-Perez, M. ;

Goyal, M. ;

Demchuk, A. M. ;

von Kummer, R. ;

Gallofre, M. ;

Davalos, A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (24) :2296-2306

[10] Early Recanalization Postintravenous Thrombolysis in Ischemic Stroke with Large Vessel Occlusion: A Digital Subtraction Angiography Study [J].

Mao, Yi-Ting ;

Mitchell, Peter ;

Churilov, Leonid ;

Dowling, Richard ;

Dong, Qiang ;

Yan, Bernard .

CNS NEUROSCIENCE & THERAPEUTICS, 2016, 22 (08) :643-647

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