Abstract
Endovascular thrombectomy (EVT) is standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), but data on nationwide performance in routine healthcare are sparse. The study aims were to describe EVT patients with LVO AIS, analyze mortality and functional outcome, and compare results with randomized controlled trials (RCTs). Data from the Riksstroke and the Swedish Endovascular Treatment of Acute Stroke Registry (RSEVAS) on pre-stroke independent patients, with LVO AIS in 2017-2019, defined as occlusion of the intracranial internal carotid artery, or the M1 or M2 segments of the middle cerebral artery, and groin puncture <6 h of onset, were compared to aggregated HERMES collaboration RCT data. We assessed 90-day survival and function, defined by the modified Rankin Scale. Specific analyzes were stratified by occlusion location. In all, 1011/2560 of RSEVAS patients matched RCT inclusion criteria. Compared with RCT data, patients were older (73 vs. 68), fewer received intravenous thrombolysis (63.1% vs. 83%), and M2 occlusions were more common (24.5% vs. 8%). 90-day survival in RSEVAS was 85.3%, 42.8% achieved good outcome and 5% had symptomatic intracerebral hemorrhage (sICH). Corresponding outcomes in RCT data were 84.7% survival, 46% good outcome, and 4.4% sICH. Functional outcome was most favorable following M2 occlusions. EVT patients from our large real-world national dataset differed from RCT patients in several baseline factors including distribution of vascular occlusion site. However, the overall outcome of EVT in our Swedish cohort appeared to well match the pivotal trial findings.
Highlights
All patients ≥18 years [1] registered in both RS and EndoVAscular Treatment of Stroke Register (EVAS) registries during 2017–2019 [2] who were pre-stroke independent defined as modified Rankin scale score 0– 2 AND [3] had groin puncture within six hours from symptom onset AND [4] anterior circulation large vessel occlusion (LVO) defined as either the intracranial internal carotid artery (ICA), or the M1 or M2 segment of the middle cerebral artery (MCA), were included for analysis and compared to a meta-analysis using pooled data (EVT arm only) from five randomized trials published in 2016.13 These trials were heterogenous regarding patient selection
In 2017–2019, 2560 patients were registered in Register (EVAS)12 jointly (RSEVAS) and 39% (1011; 2017 n = 280, 2018 n = 338, 2019 n = 393) fulfilled the HERMES inclusion criteria, without significant differences between the years
M2 occlusions were more common in RSEVAS (24.5% vs. 8%)
Summary
In the wake of several ground-breaking randomized controlled trials (RCTs), endovascular thrombectomy (EVT) has become the new standard of care for acute ischemic stroke (AIS) with anterior circulation large vessel occlusion (LVO).. Endovascular thrombectomy (EVT) is standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), but data on nationwide performance in routine healthcare are sparse. The study aims were to describe EVT patients with LVO AIS, analyze mortality and functional outcome, and compare results with randomized controlled trials (RCTs). Methods: Data from the Riksstroke and the Swedish Endovascular Treatment of Acute Stroke Registry (RSEVAS) on pre-stroke independent patients, with LVO AIS in 2017–2019, defined as occlusion of the intracranial internal carotid artery, or the M1 or M2 segments of the middle cerebral artery, and groin puncture
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