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Case–Control Study of Endovascular Thrombectomy in a Canadian Stroke Center

  • Sherry X. Hu (a1), Karim Virani (a2), Jai J. S. Shankar (a2), Christine A. Christian (a3), Kara J. Matheson (a4), Huiling Cao (a5), Wendy L. Simpkin (a3) and Stephen J. Phillips (a1)...

Abstract:

Background:

Although the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke caused by intracranial anterior circulation large vessel occlusion (LVO) is proven, demonstration of local effectiveness is critical for health system planning and resource allocation because of the complexity and cost of this treatment.

Methods:

Using our prospective registry, we identified all patients who underwent EVT for out-of-hospital LVO stroke from February 1, 2013 through January 31, 2017 (n = 44), and matched them 1:1 in a hierarchical fashion with control patients not treated with EVT based on age (±5 years), prehospital functional status, stroke syndrome, severity, and thrombolysis administration. Demographics, in-hospital mortality, discharge disposition from acute care, length of hospitalization, and functional status at discharge from acute care and at follow-up were compared between cases and controls.

Results:

For EVT-treated patients (median age 66, 50% women), the median onset-to-recanalization interval was 247 min, and successful recanalization was achieved in 30/44 (91%). Alteplase was administered in 75% of cases and 57% of controls (p = 0.07). In-hospital mortality was 11% among the cases and 36% in the control group (p = 0.006); this survival benefit persisted during follow-up (p = 0.014). More EVT patients were discharged home from acute care (50% vs. 18%, p = 0.002). Among survivors, there were nonsignificant trends in favor of EVT for median length of hospitalization (14 vs. 41 days, p = 0.11) and functional independence at follow-up (51% vs. 32%, p = 0.079).

Conclusion:

EVT improved survival and decreased disability. This demonstration of single-center effectiveness may help facilitate expansion of EVT services in similar health-care jurisdictions.

Étude cas-témoin portant sur la thrombectomie endovasculaire dans un centre canadien de prise en charge des AVC. Contexte : Bien qu’on ait prouvé l’efficacité de la thrombectomie endovasculaire dans le cas d’accidents ischémiques cérébraux aigus causés par l’occlusion de grosses artères affectant la circulation antérieure intracrânienne, la démonstration de son efficacité sur le terrain est essentielle à la planification du réseau la santé et à l’allocation des ressources en raison de la complexité de ce traitement et des coûts qui y sont associés. Méthodes : À l’aide d’un registre prospectif, nous avons identifié tous les patients ayant bénéficié (n = 44), du 1er février 2013 au 31 janvier 2017, d’une thrombectomie endovasculaire à la suite d’un AVC survenu en dehors d’un établissement de la santé, AVC causé par l’occlusion de grosses artères. De manière hiérarchique, nous avons fait correspondre nos patients dans un rapport de 1 à 1 à nos témoins non traités par thrombectomie endovasculaire, et ce, en nous basant sur leur âge (± 5 ans), sur leur situation fonctionnelle avant d’être admis, sur les signes cliniques et la gravité de leur AVC, et sur l’administration d’un traitement thrombolytique. Nous avons également comparé leurs caractéristiques démographiques, leur taux de mortalité hospitalière, les modalités d’obtention d’un congé des soins intensifs, la durée de leur hospitalisation et leur situation fonctionnelle au moment de quitter les soins intensifs et à l’occasion d’un suivi. Résultats : Dans le cas de nos patients traités par thrombectomie endovasculaire (âge médian : 66 ans ; 50 % de femmes), l’intervalle médian entre les premiers signes d’un AVC et la recanalisation a été de 247 minutes. Fait à souligner, une recanalisation réussie a été accomplie dans 30 cas sur 44 (91 %). L’altéplase a été administré dans 75 % des cas et chez 57 % des témoins (p = 0,07). En ce qui concerne le taux de mortalité hospitalière, il a été de 11 % parmi tous nos cas et de 36 % chez nos témoins (p = 0,006) ; À noter que cet avantage en termes de survie a persisté au moment des suivis (p = 0,014). Plus de patients traités par thrombectomie endovasculaire ont obtenu leur congé des soins intensifs et sont revenus à la maison (50 % contre 18 % ; p = 0,002). Parmi les survivants à ces AVC, on a noté des tendances non significatives en faveur des patients traités par thrombectomie endovasculaire pour ce qui est de la durée médiane d’hospitalisation (14 jours contre 41 jours ; p = 0,11) et de l’autonomie fonctionnelle au moment des suivis (51 % contre 32 % ; p = 0,079). Conclusion : En somme, la thrombectomie endovasculaire a permis d’améliorer le taux de survie des patients ainsi que leur niveau d’autonomie fonctionnelle. Effectuée dans un seul établissement hospitalier, cette démonstration de l’efficacité de ce traitement pourrait contribuer à faciliter l’essor des traitements de thrombectomie endovasculaire dans d’autres systèmes de santé similaires.

Copyright

Corresponding author

Correspondence to: Stephen Phillips, Department of Medicine, Division of Neurology, Dalhousie University and Nova Scotia Health Authority, 1796 Summer St., Room 3835B, Halifax, NS B3H 2A7, Canada. Email: stephen.phillips@dal.ca

References

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Keywords

Case–Control Study of Endovascular Thrombectomy in a Canadian Stroke Center

  • Sherry X. Hu (a1), Karim Virani (a2), Jai J. S. Shankar (a2), Christine A. Christian (a3), Kara J. Matheson (a4), Huiling Cao (a5), Wendy L. Simpkin (a3) and Stephen J. Phillips (a1)...

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