Functional Outcome After Primary Endovascular Therapy or IV Thrombolysis Alone for Stroke. An Observational, Comparative Effectiveness Study
Por:
Abilleira, S, Ribera, A, Davalos, A, Ribo, M, Chamorro, A, Cardona, P, Molina, CA, Martinez-Yelamos, A, Urra, X, Dorado, L, Roquer, J, Marti-Fabregas, J, Aja, L, Tomasello, A, Castano, C, Blasco, J, Canovas, D, Castellanos, M, Krupinski, J, Guimaraens, L, Perendreu, J, Ustrell, X, Purroy, F, Gomez-Choco, M, Baiges, JJ, Cocho, D, Saura, J, Gallofre, M
Publicada:
1 dic 2014
Resumen:
Background: Among the acute ischemic stroke patients with large vessel occlusions and contraindications for the use of IV thrombolysis, mainly on oral anticoagulation or presenting too late, primary endovascular therapy is often performed as an alternative to the standard therapy even though evidence supporting the use of endovascular reperfusion therapies is not yet established. Using different statistical approaches, we compared the functional independence rates at 3 months among patients undergoing primary endovascular therapy and patients treated only with IV thrombolysis. Methods: We used data from a prospective, government-mandated and externally audited registry of reperfusion therapies for ischemic stroke (January 2011 to November 2012). Patients were selected if treated with either IV thrombolysis alone (n = 1,582) or primary endovascular thrombectomy (n = 250). A series of exclusions were made to homogenize the clinical characteristics among the two groups. We then carried out multivariate logistic regression and propensity score matching analyses on the final study sample (n = 1,179) to compare functional independence at 3 months, as measured by the modified Rankin scale scores 0-2, between the two groups. Results: The unadjusted likelihood of good outcome was poorer among the endovascular group (OR: 0.69; 95% CI: 0.47-1.0). After adjustment, no differences by treatment modality were seen (OR: 1.51; 95% CI: 0.93-2.43 for primary endovascular therapy). Patients undergoing endovascular thrombectomy within 180-270 min (OR: 2.89; 95% CI: 1.17-7.15) and patients with severe strokes (OR: 1.84; 95% CI: 1.02-3.35) did better than their intravenous thrombolysis counterparts. The propensity score-matched analyses with and without adjustment by additional covariates showed that endovascular thrombectomy was as effective as intravenous thrombolysis alone in achieving functional independence (OR for unadjusted propensity score matched: 1.35; 95% CI: 0.9-2.02, OR for adjusted propensity score matched: 1.45; 95% CI: 0.91-2.32). Conclusion: This comparative effectiveness study shows that in ischemic stroke patients with contraindications for IV thrombolysis, primary endovascular treatment might be an alternative therapy at least as effective as IV thrombolysis alone. Randomized controlled trials are urgently needed. (C) 2014 S. Karger AG, Basel
Filiaciones:
Abilleira, S:
Agcy Hlth Qual & Assessment Catalonia, Stroke Program, ES-08005 Barcelona, Spain
Ribera, A:
Agcy Hlth Qual & Assessment Catalonia, Stroke Program, ES-08005 Barcelona, Spain
Davalos, A:
Hosp Badalona Germans Trias & Pujol, Dept Neurosci, Badalona, Spain
Ribo, M:
Hosp Valle De Hebron, Neurovasc Unit, Barcelona, Spain
Chamorro, A:
Hosp Clin I Prov, Funct Unit Cerebrovasc Dis, Barcelona, Spain
Cardona, P:
Hosp Llobregat, Hosp Bellvitge, Lhospitalet De Llobregat, Spain
Molina, CA:
Hosp Valle De Hebron, Neurovasc Unit, Barcelona, Spain
Martinez-Yelamos, A:
Hosp Llobregat, Hosp Bellvitge, Lhospitalet De Llobregat, Spain
Urra, X:
Hosp Clin I Prov, Funct Unit Cerebrovasc Dis, Barcelona, Spain
Dorado, L:
Hosp Badalona Germans Trias & Pujol, Dept Neurosci, Badalona, Spain
Roquer, J:
Hosp del Mar, Barcelona, Spain
Marti-Fabregas, J:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Aja, L:
Hosp Llobregat, Hosp Bellvitge, Lhospitalet De Llobregat, Spain
Tomasello, A:
Hosp Valle De Hebron, Neurovasc Unit, Barcelona, Spain
Castano, C:
Hosp Badalona Germans Trias & Pujol, Dept Neurosci, Badalona, Spain
Blasco, J:
Hosp Clin I Prov, Funct Unit Cerebrovasc Dis, Barcelona, Spain
Canovas, D:
Corp Sanit Parc Tauli, Sabadell, Spain
Castellanos, M:
Hosp Josep Trueta, Girona, Spain
Krupinski, J:
Hosp Mutua Terrassa, Terrassa, Spain
Guimaraens, L:
Hosp del Mar, Barcelona, Spain
Perendreu, J:
Corp Sanit Parc Tauli, Sabadell, Spain
Ustrell, X:
Hosp Joan 23, Tarragona, Spain
Purroy, F:
Hosp Arnau Vilanova, Lleida, Spain
Gomez-Choco, M:
Hosp Moises Broggi, St Joan Despi, Spain
Baiges, JJ:
Hosp Verge de la Cinta, Tortosa, Spain
Cocho, D:
Fundacio Asil Granollers, Granollers, Spain
Saura, J:
Fundacio Althaia, Manresa, Spain
Gallofre, M:
Agcy Hlth Qual & Assessment Catalonia, Stroke Program, ES-08005 Barcelona, Spain
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