Abstract WP31: Mechanical Thrombectomy Performs Similarly in Real-World Clinical Practise as in Randomized Trials: Nationwide Study From the Czech Republic

Abstract

Background: In randomized clinical trials (RCTs) mechanical thrombectomy (MT) was proved to be a highly effective and safe treatment in acute ischemic stroke. Its efficacy and safety in routine practice needs to be documented. Methods: Available nationwide 2016 data for the Czech Republic (CR) from SITS-TBY registry of patients with terminal internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusion were compared with data from HERMES meta-analysis. Categorical variables were compared by Pearson′s Chi-squared test, ordinal/continuous variables by Mann-Whitney test. Results: Fourteen/15 comprehensive stroke centres reported data to SITS-TBY. From 1,053 MTs performed in the CR, 845 (80%) patients were reported to SITS-TBY. From these patients, 605 (72%) patients were involved in analyses (available outcome data in Tab.). CR and HERMES patients were comparable in: age, sex, baseline NIHSS. Occlusion locations were as follows (CR vs. HERMES): ICA 22% vs. 21% (p=0.16), M1 MCA 62% vs. 69% (p=0.004), M2 MCA 16% vs. 8% (p<0.0001). Intravenous thrombolysis was given in 76% vs. 83% patients (p=0.003). Median onset-to-reperfusion times were comparable: 232 vs. 285 min (p=0.66); median groin-to-reperfusion times were 58 vs. 63 min. Modified TICI 2b/3 was achieved in 74% (433/584) vs. 71% (390/549), p=0.24. There was no difference in percentage of PH type 2 (5.7 vs. 5.1%). Modified Rankin scale 0-2 at 3 months achieved 44% (103/235) vs. 46% (291/633) patients, p=0.57. Conclusions: This nationwide experience on mechanical thrombectomy in acute ischemic stroke documents safety, efficacy and logistics comparable with HERMES data. Tab. Comparison on available demographic characteristics, past medical history, clinical and radiological characteristics, treatment details and outcomes in SITS-TBY versus HERMES.