Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry.

Autor:	Rudilosso S; Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.; Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain., Ríos J; Medical Statistics Core Facility, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Hospital Clinic, Barcelona, Spain.; Biostatistics Unit, Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain., Rodríguez A; Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain., Gomis M; Stroke Unit, Department of Neuroscience, Germans Trias Hospital, Badalona, Spain., Vera V; Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain., Gómez-Choco M; Department of Neurology, Moisès-Broggi Hospital, Sant Joan Despí, Spain., Renú A; Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.; Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain., Matos N; Department of Neurology, Althaia Foundation Hospital, Manresa, Spain., Llull L; Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.; Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain., Purroy F; Stroke Unit, Department of Neurology, University Hospital Arnau of Vilanova, Lleida, Spain., Amaro S; Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.; Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain., Terceño M; Stroke Unit, Department of Neurology, Josep Trueta University Hospital, Girona, Spain., Obach V; Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain., Serena J; Stroke Unit, Department of Neurology, Josep Trueta University Hospital, Girona, Spain., Martí-Fàbregas J; Stroke Unit, Department of Neurology, Santa Creu i Sant Pau, Barcelona, Spain., Cardona P; Stroke Unit, Department of Neurology, Bellvitge University Hospital, Barcelona, Spain., Molina C; Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain., Rodríguez-Campello A; Stroke Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain., Cánovas D; Department of Neurology, Parc Taulí Hospital, Sabadell, Spain., Krupinski J; Department of Neurology, Mutua de Terrassa University Hospital, Terrassa, Spain., Ustrell X; Stroke Unit, Department of Neurology, Joan XXIII University Hospital, Terragona, Spain., Torres F; Medical Statistics Core Facility, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Hospital Clinic, Barcelona, Spain.; Biostatistics Unit, Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain., Román LS; Department of Radiology, Hospital Clínic of Barcelona, Barcelona, Spain., Salvat-Plana M; Department of Health, Pla Director Malaltia Vascular Cerebral (Catalan Stroke Program), Barcelona, Spain., Jiménez-Fàbrega FX; Emergency Medical Services of Catalonia, Barcelona, Spain., Palomeras E; Department of Neurology, Hospital of Mataró, Mataró, Spain., Catena E; Department of Neurology, Consorci Sanitari Garraf Hospital, Sant Pere de Ribes, Spain., Colom C; Department of Emergency, Hospital of Igualada, Igualada, Spain., Cocho D; Department of Emergency, Hospital of Granollers, Granollers, Spain., Baiges J; Department of Emergency, Verge de la Cinta Hospital, Tortosa, Spain., Aragones JM; Department of Emergency, Vic University Hospital, Vic, Spain., Diaz G; Department of Emergency, Hospital of Campdevànol, Campdevànol, Spain., Costa X; Department of Emergency, Hospital of Figueres, Figueres, Spain., Almendros MC; Department of Emergency, Hospital of Palamós, Palamós, Spain., Rybyeba M; Department of Emergency, Hospital of Olot, Olot, Spain., Barceló M; Department of Emergency, Cerdanya Hospital, Puigcerdá, Spain., Carrión D; Department of Emergency, Hospital of Móra d'Ebre, Móra d'Ebre, Spain., Lòpez MN; Department of Emergency, Seu d'Urgell Hospital, Seu d'Urgell, Spain., Sanjurjo E; Department of Emergency, Hospital of Tremp, Tremp, Spain., de la Ossa NP; Stroke Unit, Department of Neuroscience, Germans Trias Hospital, Badalona, Spain.; Department of Health, Pla Director Malaltia Vascular Cerebral (Catalan Stroke Program), Barcelona, Spain., Urra X; Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.; Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain., Chamorro Á; Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.; Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.; University of Barcelona, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	Journal of stroke [J Stroke] 2021 Sep; Vol. 23 (3), pp. 401-410. Date of Electronic Publication: 2021 Sep 30.
DOI:	10.5853/jos.2021.00962
Abstrakt:	Background and Purpose:  In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods:  Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score <6, proximal vertebrobasilar occlusion, supratherapeutic international normalized ratio >3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups' criteria). Results:  Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). Conclusions:  Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.
Databáze:	MEDLINE
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