Journal
STROKE
Volume 52, Issue 5, Pages 1589-1600Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.120.031599
Keywords
cohort studies; stroke; thrombectomy; thrombolytic therapy; tissue-type plasminogen activator
Categories
Funding
- National Key R&D Program of China [2016YFC1301500, 2018YFC1312801]
- China Postdoctoral Science Foundation [2019M650773]
Ask authors/readers for more resources
This study validated the results of the DIRECT-MT trial in a real-world practice setting in China, indicating that MT may have similar effectiveness to combined IVT+MT for patients with acute large vessel occlusion. Despite MT alone being associated with shorter in-hospital delay until procedure, lower risks of symptomatic intracranial hemorrhage, and embolization.
BACKGROUND AND PURPOSE: A recent randomized controlled trial DIRECT-MT (Direct Intra-Arterial Thrombectomy to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals) compared the safety and efficacy of mechanical thrombectomy (MT) versus combined intravenous thrombolysis (IVT) and MT for acute large vessel occlusion. The current study utilized a prospective, nationwide registry to validate the results of the DIRECT-MT trial in a real-world practice setting. METHODS: Subjects were selected from a prospective cohort of acute large vessel occlusion patients undergoing endovascular treatment at 111 hospitals from 26 provinces in China (ANGEL-ACT registry [Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke]) between November 2017 and March 2019. All patients eligible for IVT and receiving MT were reviewed and then grouped according to whether prior IVT or not (MT and combined IVT+MT). After a 1:1 propensity score matching, the outcome measures including the 90-day modified Rankin Scale, successful recanalization, door-to-puncture time, symptomatic intracranial hemorrhage, and intraprocedural embolization were compared. RESULTS: A total of 1026 patients, 600 in the MT group and 426 in the combined group, were included. Among 788 patients identified after matching, there were no significant differences in the 90-day modified Rankin Scale (median, 3 versus 3 points; P=0.82) and successful recanalization (86.6% versus 89.3%; P=0.23) between the two groups; however, patients of the MT group had a shorter door-to-puncture time (median, 112 versus 136 minutes; beta=-45.02 [95% CI, -68.31 to -21.74]), lower rates of symptomatic intracranial hemorrhage (5.5% versus 10.1%; odds ratio, 0.52 [95% CI, 0.30-0.91]), and embolization (4.6% versus 8.1%; odds ratio, 0.54 [95% CI, 0.30-0.98]) than those of the combined group. CONCLUSIONS: This matched-control study largely confirmed the findings of the DIRECT-MT trial in a real-world practice setting, suggesting that MT may carry similar effectiveness to combined IVT+MT for acute large vessel occlusion patients, despite MT alone seems to be associated with a shorter in-hospital delay until procedure, lower risks of symptomatic intracranial hemorrhage, and embolization. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available