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Clinical effectiveness of endovascular stroke treatment in the early and extended time windows
Journal article   Open access   Peer reviewed

Clinical effectiveness of endovascular stroke treatment in the early and extended time windows

Raul G Nogueira, Diogo C Haussen, David S Liebeskind, Tudor G Jovin, Rishi Gupta, Jeffrey L Saver, Ashutosh P Jadhav, Ronald F Budzik, Blaise Baxter, Antonin Krajina, …
International journal of stroke, v 17(4), pp 389-399
Apr 2022
DOI: https://doi.org/10.1177/17474930211005740
PMID: 33705210
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1177/17474930211005740View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open

Abstract

Brain Ischemia - therapy Endovascular Procedures - methods Humans Stroke - drug therapy Stroke - surgery Thrombectomy - methods Tissue Plasminogen Activator - therapeutic use Treatment Outcome
The clinical efficacy of mechanical thrombectomy has been unequivocally demonstrated in multiple randomized clinical trials. However, these studies were performed in carefully selected centers and utilized strict inclusion criteria. We aimed to assess the clinical effectiveness of mechanical thrombectomy in a prospective registry. A total of 2008 patients from 76 sites across 12 countries were enrolled in a prospective open-label mechanical thrombectomy registry. Patients were categorized into the corresponding cohorts of the SWIFT-Prime, DAWN, and DEFUSE 3 trials according to the basic demographic and clinical criteria without considering specific parenchymal imaging findings. Baseline and outcome variables were compared across the corresponding groups. As compared to the treated patients in the actual trials, registry-derived patients tended to be younger and had lower baseline ASPECTS. In addition, time to treatment was earlier and the use of intravenous tissue plasminogen activator (IV-tPA) and general anesthesia were higher in DAWN- and DEFUSE-3 registry derived patients versus their corresponding trials. Reperfusion rates were higher in the registry patients. The rates of 90-day good outcome (mRS0-2) in registry-derived patients were comparable to those of the patients treated in the corresponding randomized clinical trials (SWIFT-Prime, 64.5% vs. 60.2%; DAWN, 50.4% vs. 48.6%; Beyond-DAWN: 52.4% vs. 48.6%; DEFUSE 3, 52% vs. 44.6%, respectively; all  > 0.05). Registry-derived patients had significant less disability than the corresponding randomized clinical trial controls (ordinal modified Rankin Scale (mRS) shift odds ratio (OR),  < 0.05 for all). Our study provides favorable generalizability data for the safety and efficacy of thrombectomy in the "real-world" setting and supports that patients may be safely treated outside the constraints of randomized clinical trials.

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12 Record Views
17 citations in Web of Science
13 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Clinical Neurology
Peripheral Vascular Disease
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