Changing Trends in Hyperacute Stroke Treatment and Early Clinical Outcomes Reflecting Recent Improvement in Endovascular Thrombectomy Techniques

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Published: Dec 18, 2017
DOI: https://doi.org/10.18192/uojm.v0i0.2126
Keywords:
Stroke, Thrombectomy, Ischemic, Hyperacute

Main Article Content

Travis William Davidson
University of Ottawa
Santanu Chakraborty
University of Ottawa, Faculty of Medicine

Abstract




Objective: Ischemic stroke is a major disease causing death and permanent neurological disability with the mainstay treatment being to re-established blood flow as quickly as possible. Recent changes in the efficiency of endovascular devices performing thrombectomies have led to it now being considered the gold standard. Nevertheless, successful endovascular thrombectomy (EVT) requires access to many resources and expertise which may impact its effectiveness. The objective of the current study is to describe the application and utility of EVT in the clinical treatment of ischemic stroke at a single tertiary care hospital.


Methods: This is a descriptive retrospective cohort study from a stroke database. A total of 548 patients diagnosed with an ischemic stroke affecting large cerebral arteries between January 2010 and June 2016 were included. National Institute of Health Stroke Scale (NIHSS) score was used to evaluate stroke severity upon admission. Modified Ranking Scale was used to determine the functional status of patients upon discharge. Successful reperfusion defined as a TICI score of 2B or 3, age, thrombolytic use and time- to-treatment were all considered for analysis.


Results: Thrombectomies became more frequent (p<0.001) with shorter time-to-treatment in recent years (p=0.001). A successful thrombectomy has significantly improved functional status at discharge (p<0.001), even when thrombolytics were not given (p=0.003) or when patients were over 80 years old (p=0.021).


Conclusion: The current work provides evidence that this single hospital has increased its frequency of application of EVT for ischemic stroke, leading to a better functional outcome at discharge independent of prior thrombolysis or age. 




Article Details

Issue
Vol. 8 No. 1 (2018): Surgery and Transplantation
Section
Original Research
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Author Biography

Santanu Chakraborty, University of Ottawa, Faculty of Medicine

Dr. Santanu Chakraborty is an associate professor in the Department of Radiology at the University of Ottawa.

References

1. Krueger H, Koot J, Hall RE, O’Callaghan C, Bayley M, Corbett D. Prevalence of individuals experiencing the effects of stroke in Canada. Stroke. 2015;46(8):2226-31. 


2. Powers WJ, Derdeyn CP, Biller J, et al. 2015 american heart association/american stroke association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2015;46(10):3020- 35. 


3. Harris DR, Lang ES, Perry JJ, Morrison LJ. Treatment of stroke in canadian emergency departments: Time to be leaders. CJEM. 2017;19(1)47-9. 


4. Harris D, Hall C, Lobay K, et al. Canadian association of emergency physicians position statement on acute ischemic stroke. CJEM. 2015;17(2):217- 26. 


5. Maingard J, Yan B. Future directions for intra-arterial therapy for acute ischaemic stroke: Is there life after three negative randomized controlled studies? Interv Neurol. 2014;2(3):97-104. 


6. Beadell NC, Bazan T, Lutsep H. The year embolectomy won: A review of five trials assessing the efficacy of mechanical intervention in acute stroke. Curr Cardiol Rep. 2015;17(11):102 


7. Palaniswami M, Yan B. Mechanical thrombectomy is now the gold standard for acute ischemic stroke: Implications for routine clinical practice. Interv Neurol. 2015;4(1-2):18-29. 


8. Casaubon LK, Boulanger JM, Blacquiere D, et al. Canadian stroke best practice recommendations: Hyperacute stroke care guidelines, update 2015. Int J Stroke. 2015;10(6):924-40. 


9. Tsivgoulis G, Katsanos AH, Mavridis D, Magou s G, Arthur A, Alexandrov AV. Mechanical thrombectomy improves functional outcomes independent of pretreatment with intravenous thrombolysis. Stroke. 2016;47(6):1661-4.

10. Purrucker JC, Wolf M, Haas K, et al. Safety of endovascular thrombectomy in patients receiving non-vitamin k antagonist oral anticoagulants. 
Stroke. 2016;47(4):1127-30. 


11. Chia NH, Leyden JM, Newbury J, Jannes J, Kleinig TJ. Determining the 
number of ischemic strokes potentially eligible for endovascular thrombectomy: A population-based study. Stroke. 2016;47(5):1377-80. 


12. Chakraborty S, Ross J, Hogan MJ, Dowlatshahi D, Stotts G. Beating the clock: Time delays to thrombolytic therapy with advanced imaging and impact of optimized work flow. J Stroke Cerebrovasc Dis. 2015;24(6):1270-5. 


13. Schlegel D, Kolb SJ, Luciano JM, et al. Utility of the nih stroke scale as a predictor of hospital disposition. Stroke. 2003;34(1):134-7. 

14. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604-7. 


15. Fugate JE, Klunder AM, Kallmes DF. What is meant by “tici”? AJNR Am J Neuroradiol. 2013;34(9):1792-7. 


16. Hills NK, Johnston SC. Why are eligible thrombolysis candidates left untreated? Am J Prev Med. 2006;31(6 Suppl 2):S210-6. 


17. Harvey RL. Predictors of functional outcome following stroke. Phys Med Rehabil Clin N Am 2015;26(4):583-98. 


18. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient
data from five randomised trials. Lancet. 2016;387(10029):1723-31. 


19. Ciccone A, Valvassori L, Nichelatti M, et al. Endovascular treatment for acute ischemic stroke. N Engl J Med. 2013;368(5):904-13. 


20. Kidwell CS, Jahan R, Gornbein J, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013;368(10):914-23. 


21. Gerber J, Puetz V, Bodechtel U, Kitzler H, von Kummer R, Linn J. Endovascular treatment of ischaemic stroke patients - new evidence and old challenges. Vasa. 2016;45(4):267-74. 


22. Kumar G, Shahripour RB, Alexandrov AV. Recanalization of acute basilar artery occlusion improves outcomes: A meta-analysis. J Neurointerv Surg 2015;7(12):868-74.

23. Slater LA, Coutinho JM, Gralla J, et al. Tici and age: What’s the score? AJNR Am J Neuroradiol. 2016;37(5):838-43. 


24. Esenwa C, Gutierrez J. Secondary stroke prevention: Challenges and solutions. Vasc Health Risk Manag. 2015;11:437-50. 


25. Przybylowski CJ, Ding D, Starke RM, Durst CR, Crowley RW, Liu KC. Evolution of endovascular mechanical thrombectomy for acute ischemic stroke. World J Clin Cases. 2014;2(11):614-22.