Mechanical thrombectomy for anterior circulation stroke: 5-year experience in a statewide service with differences in pretreatment time metrics across two hospitals sites
| Autor: | David Blacker, Ruchi Kabra, Graeme J. Hankey, Jacqui Saw, Tejinder Singh, David Prentice, Darshan Ghia, William McAuliffe, Constantine C. Phatouros, Timothy J Phillips |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Subgroup analysis Arteriotomy 030204 cardiovascular system & hematology law.invention Time-to-Treatment Cohort Studies Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Modified Rankin Scale law medicine Humans Prospective Studies Prospective cohort study Stroke Aged Retrospective Studies Thrombectomy Aged 80 and over Cerebral infarction business.industry General Medicine Thrombolysis Middle Aged medicine.disease Surgery Treatment Outcome Emergency medicine Reperfusion Female Neurology (clinical) business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Journal of neurointerventional surgery. 9(6) |
| ISSN: | 1759-8486 |
| Popis: | ObjectiveTo audit our institutional mechanical thrombectomy (MT) outcomes for acute anterior circulation stroke and examine the influence of workflow time metrics on patient outcomes.MethodsA database of 100 MT cases was maintained throughout May 2010—February 2015 as part of a statewide service provided across two tertiary hospitals (H1 and H2). Patient demographics, stroke and procedural details, blinded angiographic outcomes, and 90-day modified Rankin Scale (mRS) scores were recorded. The following time points in stroke treatment were recorded: stroke onset, hospital presentation, CT imaging, arteriotomy, and recanalization. Statistical analysis of outcomes, predictors of outcome, and differences between the hospitals was carried out.ResultsThrombolysis in Cerebral Infarction (TICI) 2b/3 reperfusion was 79%. Forty-nine per cent of patients had good clinical outcomes (mRS 0–2). In a subgroup analysis of 76 patients with premorbid mRS 0–1 and first CT performed ≤4.5 h after stroke onset, 60% had good clinical outcomes. Patient and disease characteristics were matched between the two hospitals. H1 had shorter times between hospital presentation and CT (32 vs 55 min, p=0.01), CT and arteriotomy (33 vs 69 min, p=0.00), and stroke onset and recanalization (198 vs 260 min, p=0.00). These time metrics independently predicted good clinical outcome. Median days spent at home in the first 90 days was greater at H1 (61 vs 8, p=0.04) than at H2. A greater proportion of patients treated at H1 were independent (mRS 0–2) at 90 days (54% vs 42%); however, this was not statistically significant (p=0.22).ConclusionsOutcomes similar to randomized controlled trials are attainable in ‘real-world’ settings. Workflow time metrics were independent predictors of clinical outcome, and differed between the two hospitals owing to site-specific organizational differences. |
| Databáze: | OpenAIRE |
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