Outcome After Thrombectomy and Intravenous Thrombolysis in Patients With Acute Ischemic Stroke
| Autor: | Minnerup, Jens, Wersching, Heike, Teuber, Anja, Wellmann, Jürgen, Eyding, Jens, Weber, Ralph, Reimann, Gernot, Weber, Werner, Krause, Lars Udo, Kurth, Tobias, Berger, Klaus, Homberg, V., Petrovitch, A., Heuser, L., Mönnigs, P., Krogias, C., Wallner, B., Hennigs, S., Ahlers, A., Sahl, H., Ranft, A., Dobis, C., Brassel, F., Nolden-Koch, M., Schmitt, H., Chapot, R., Nordmeyer, H., Schlamann, M., Weimar, C., Busch, F., Busch, E. W., Sigges, E., Ruf, H., Wohlfahrt, K., Karatschai, R., Klein, B., Höhle, T., Haass, A., Nasreldein, A., Büchele, B., Gahn, G., Sterker, M., Hantel, T., Krämer, C., Henningsen, H., Adelt, I., König, M., Schmidt, C., Hofmann, A., Niederstadt, T., Unrath, M., Rehfeldt, T., Fauser, B., Pfeiffer, A., Lowens, S., Stögbauer, F., Staudacher, T., Erdmann, P., Grotemeyer, K. H., Spüntrup, E., Bücke, P., Wienecke, P., Faiss, J., Wolzik-Großmann, M., Brune, N., Isenmann, S., Thomas, C., Mucha, D. |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_treatment Medizin 030204 cardiovascular system & hematology Brain Ischemia law.invention 0302 clinical medicine Randomized controlled trial Modified Rankin Scale law Germany Outcome Assessment Health Care Thrombolytic Therapy Advanced and Specialised Nursing Prospective Studies Registries Stroke Thrombectomy Aged 80 and over informed consent Thrombolysis Middle Aged stroke Combined Modality Therapy reperfusion thrombectomy Female Cardiology and Cardiovascular Medicine medicine.medical_specialty Clinical Neurology Observational Study 03 medical and health sciences Journal Article medicine Humans Comparative Study Aged Advanced and Specialized Nursing business.industry Odds ratio medicine.disease mortality Confidence interval Surgery Propensity score matching Observational study Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Stroke, 47(6), 1584. Lippincott Williams and Wilkins |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.116.012619 |
| Popis: | Background and Purpose— In patients with ischemic stroke, randomized trials showed a better functional outcome after endovascular therapy with new-generation thrombectomy devices compared with medical treatment, including intravenous thrombolysis. However, effects on mortality and the generalizability of results to routine clinical practice are uncertain. Methods— In a prospective observational register-based study patients with ischemic stroke treated either with thrombectomy, intravenous thrombolysis, or their combination were included. Primary outcome was the modified Rankin scale score (0 [no symptoms] to 6 [death]) at 3 months. Ordinal logistic regression was used to estimate the common odds ratio as treatment effects (shift analysis). Propensity score matching was applied to compare patients treated either with intravenous thrombolysis alone or with intravenous thrombolysis plus thrombectomy. Results— Among 2650 recruited patients, 1543 received intravenous thrombolysis, 504 underwent thrombectomy, and 603 received intravenous thrombolysis in combination with thrombectomy. Later time-to-treatment was associated with worse outcomes among patients treated with thrombectomy plus thrombolysis. In 241 pairs of propensity score–matched patients with a proximal intracranial occlusion, thrombectomy plus thrombolysis was associated with improved functional outcome (common odds ratio, 1.84; 95% confidence interval, 1.32–2.57), and reduced mortality (15% versus 33%; P Conclusions— Results from this large prospective registry show that also in routine clinical care thrombectomy plus thrombolysis compared with thrombolysis alone improved functional outcome and reduced mortality in patients with ischemic stroke. Earlier treatment was associated with better outcomes. |
| Databáze: | OpenAIRE |
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