Trends in mechanical thrombectomy and decompressive hemicraniectomy for stroke: A multicenter study
| Autor: | Anna L. Huguenard, Christine Tschoe, Adnan H. Siddiqui, Carol Kittel, Stephanie Zyck, Eyad Almallouhi, W. Christopher Fox, Stacey Q Wolfe, J Mocco, Chesney S Oravec, Kyle M Fargen, Justin F. Fraser, David J McCarthy, Grahame Gould, Robert M. Starke, Rohan Chitale, Alejandro M Spiotta, Reade De Leacy, Gregory J. Zipfel, Scott D. Simon, Sasha Vaziri |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Brain Ischemia 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Acute ischemic stroke Stroke Ischemic Stroke Retrospective Studies Thrombectomy Decompressive hemicraniectomy business.industry Original Articles General Medicine medicine.disease Mechanical thrombectomy Treatment Outcome Multicenter study Tissue Plasminogen Activator Ischemic stroke Cardiology Decompressive craniectomy Neurology (clinical) business 030217 neurology & neurosurgery Large vessel occlusion |
| Zdroj: | Neuroradiol J |
| ISSN: | 2385-1996 1971-4009 |
| DOI: | 10.1177/19714009211030526 |
| Popis: | Background and purpose Acute ischemic stroke has increasingly become a procedural disease following the demonstrated benefit of mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) on clinical outcomes and tissue salvage in randomized trials. Given these data and anecdotal experience of decreased numbers of decompressive hemicraniectomies (DHCs) performed for malignant cerebral edema, we sought to correlate the numbers of strokes, thrombectomies, and DHCs performed over the timeline of the 2013 failed thrombolysis/thrombectomy trials, to the 2015 modern randomized MT trials, to post-DAWN and DEFUSE 3. Materials and methods This is a multicenter retrospective compilation of patients who presented with ELVO in 11 US high-volume comprehensive stroke centers. Rates of tissue plasminogen activator (tPA), thrombectomy, and DHC were determined by current procedural terminology code, and specificity to acute ischemic stroke confirmed by each institution. Endpoints included the incidence of stroke, thrombectomy, and DHC and rates of change over time. Results Between 2013 and 2018, there were 55,247 stroke admissions across 11 participating centers. Of these, 6145 received tPA, 4122 underwent thrombectomy, and 662 patients underwent hemicraniectomy. The trajectories of procedure rates over time were modeled and there was a significant change in MT rate ( p = 0.002) without a concomitant change in the total number of stroke admissions, tPA administration rate, or rate of DHC. Conclusions This real-world study confirms an increase in thrombectomy performed for ELVO while demonstrating stable rates of stroke admission, tPA administration and DHC. Unlike prior studies, increasing thrombectomy rates were not associated with decreased utilization of hemicraniectomy. |
| Databáze: | OpenAIRE |
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