Mechanical Thrombectomy in and Outside the REVASCAT Trial Insights From a Concurrent Population-Based Stroke Registry
Por:
Urra, X, Abilleira, S, Dorado, L, Ribo, M, Cardona, P, Millan, M, Chamorro, A, Molina, C, Cobo, E, Davalos, A, Jovin, TG, Gallofre, M, Martí-Fàbregas J., Catalan Stroke Code Reperfusion Co
Publicada:
1 dic 2015
Resumen:
Background and Purpose-Recent trials have shown the superiority of endovascular thrombectomy (EVT) over medical therapy alone in certain stroke patients with proximal arterial occlusion. Using data from the Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke due to Anterior Circulation Large Vessel Occlusion Presenting Within 8-Hours of Symptom Onset (REVASCAT) and a parallel reperfusion treatment registry, we sought to assess the utilization of EVT in a defined patient population, comparing the outcomes of patients treated in and outside the REVASCAT trial.
Methods-SONIIA [Sistema Online d'Informacio de l'Ictus Agut], a population-based, government-mandated, prospective registry of reperfusion therapies for stroke encompassing the entire population of Catalonia, was used as data source. The registry documents 5 key inclusion criteria of the REVASCAT trial: age, stroke severity, time to treatment, baseline functional status, and occlusion site. We compared procedural, safety, and functional outcomes in patients treated inside and outside the trial.
Results-From November 2012 to December 2014, out of 17596 ischemic stroke patients in Catalonia (population 7.5 million), 2576 patients received reperfusion therapies (17/100000 inhabitants-year), mainly intravenous thrombolysis only (2036). From the remaining 540 treated with EVT, 103 patients (out of 206 randomized) were treated within REVASCAT and 437 outside the trial. Of these, 399 did not fulfill some of the study criteria, and 38 were trial candidates (8 treated at REVASCAT centers and 30 at 2 non-REVASCAT centers). The majority of procedural, safety, and functional outcomes were similar in patients treated with EVT within and outside REVASCAT.
Conclusions-REVASCAT enrolled nearly all eligible patients representing one third of all patients treated with EVT. Patients treated with EVT within and outside REVASCAT had similar outcomes, reinforcing the therapeutic value of EVT.
Filiaciones:
Urra, X:
Hosp Clin Barcelona, Stroke Unit, E-08036 Barcelona, Spain
August Pi i Sunyer Biomed Res Inst IDIBAPS, Barcelona, Spain
Abilleira, S:
Agcy Hlth Qual & Assessment Catalonia, Stroke Program, Barcelona, Spain
Dorado, L:
Hosp Germans Trias, Dept Neurosci, Badalona, Spain
Ribo, M:
Hosp Valle De Hebron, Stroke Unit, Barcelona, Spain
Cardona, P:
Bellvitge Hosp, Stroke Unit, Lhospitalet De Llobregat, Spain
Millan, M:
Hosp Germans Trias, Dept Neurosci, Badalona, Spain
Chamorro, A:
Hosp Clin Barcelona, Stroke Unit, E-08036 Barcelona, Spain
August Pi i Sunyer Biomed Res Inst IDIBAPS, Barcelona, Spain
Molina, C:
Hosp Valle De Hebron, Stroke Unit, Barcelona, Spain
Cobo, E:
Barcelona Tech, Stat & Operat Res, Barcelona, Spain
Davalos, A:
Hosp Germans Trias, Dept Neurosci, Badalona, Spain
Jovin, TG:
UPMC, Dept Neurol, Stroke Inst, Pittsburgh, PA USA
Gallofre, M:
Agcy Hlth Qual & Assessment Catalonia, Stroke Program, Barcelona, Spain
Martí-Fàbregas J.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
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