Clinical effectiveness of endovascular stroke treatment in the early and extended time windows.
Document Type
Article
Publication Title
International journal of stroke : official journal of the International Stroke Society
Abstract
BACKGROUND: 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.
AIM: We aimed to assess the clinical effectiveness of mechanical thrombectomy in a prospective registry.
METHODS: 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.
RESULTS: 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
CONCLUSION: 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.
First Page
389
Last Page
399
DOI
10.1177/17474930211005740
Publication Date
4-1-2022
Recommended Citation
Nogueira RG, Haussen DC, Liebeskind DS, Jovin TG, Gupta R, Saver JL, Jadhav AP, Budzik RF, Baxter B, Krajina A, Bonafe A, Malek A, Narata AP, Mohammaden MH, Zhang Y, Morgan P, Ji M, Bartolini B, English J, Albers GW, Mlynash M, Lansberg MG, Frankel MR, Pereira VM, Veznedaroglu E; Trevo Registry, SWIFT Prime, DEFUSE 3 and DAWN Trial Investigators. Clinical effectiveness of endovascular stroke treatment in the early and extended time windows. Int J Stroke. 2022 Apr;17(4):389-399. doi: 10.1177/17474930211005740. Epub 2021 Apr 20. PMID: 33705210.