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Pawłowski K, Dziadkiewicz A, Podlasek A, Klaudel J, Mączkowiak A, Szołkiewicz M. Thrombectomy-Capable Stroke Centre-A Key to Acute Stroke Care System Improvement? Retrospective Analysis of Safety and Efficacy of Endovascular Treatment in Cardiac Cathlab. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2232. [PMID: 36767599 PMCID: PMC9915992 DOI: 10.3390/ijerph20032232] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
The optimal structure of the acute ischaemic stroke treatment network is unknown and eagerly sought. To make it most effective, different treatment and transportation strategies have been developed and investigated worldwide. Since only a fraction of acute stroke patients with large vessel occlusion are treated, a new entity-thrombectomy-capable stroke centre (TCSC)-was introduced to respond to the growing demand for timely endovascular treatment. The purpose of this study was to present the early experience of the first 70 patients treated by mechanical means in a newly developed cardiac Cathlab-based TCSC. The essential safety and efficacy measures were recorded and compared with those reported in the invasive arm of the HERMES meta-analysis-the largest published dataset on the subject. We found no significant differences in terms of clinical and safety outcomes, such as early neurological recovery, level of functional independence at 90 days, symptomatic intracranial haemorrhage, parenchymal haematoma type 2, and mortality. These encouraging results obtained in the small endovascular centre may be an argument for the introduction of the TCSC into operating stroke networks to increase patient access to timely treatment and to improve clinical outcomes.
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Affiliation(s)
- Krzysztof Pawłowski
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Artur Dziadkiewicz
- Department of Neurology and Stroke, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Anna Podlasek
- Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, Dundee DD1 4HN, UK
- Precision Imaging Beacon, Radiological Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - Jacek Klaudel
- Department of Invasive Cardiology, St. Adalbert’s Hospital, Copernicus PL, 80-070 Gdansk, Poland
| | - Alicja Mączkowiak
- Department of Neurology and Stroke, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Marek Szołkiewicz
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
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Texakalidis P, Giannopoulos S, Karasavvidis T, Rangel-Castilla L, Rivet DJ, Reavey-Cantwell J. Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis of Stent Retrievers vs Direct Aspiration vs a Combined Approach. Neurosurgery 2020; 86:464-477. [PMID: 31313819 DOI: 10.1093/neuros/nyz258] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 04/15/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent randomized control trials (RCTs) established that mechanical thrombectomy is superior to medical therapy for patients with stroke due to a large vessel occlusion. OBJECTIVE To compare the safety and efficacy profile of the different mechanical thrombectomy strategies. METHODS A random-effects meta-analysis was performed and the I2 statistic was used to assess heterogeneity according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Nineteen studies with a total of 2449 patients were included. No differences were identified between the stent retrieval and direct aspiration groups in terms of modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 and mTICI 3 recanalization rates, and favorable outcomes (modified Rankin Scale [mRS] ≤ 2). Adverse event rates, including 90-d mortality, symptomatic intracerebral hemorrhage (sICH), and subarachnoid hemorrhage (SAH), were similar between the stent retrieval and direct aspiration groups. The use of the stent retrieval was associated with a higher risk of vasospasm (odds ratio [OR]: 2.98; 95% confidence interval [CI]: 1.10-8.09; I2: 0%) compared to direct aspiration. When compared with the direct aspiration group, the subgroup of patients who underwent thrombectomy with the combined approach as a first-line strategy had a higher likelihood of successful mTICI 2b/3 (OR: 1.47; 95% CI: 1.02-2.12; I2: 0%) and mTICI 3 recanalization (OR: 3.65; 95% CI: 1.56-8.54), although with a higher risk of SAH (OR: 4.33; 95% CI: 1.15-16.32). CONCLUSION Stent retrieval thrombectomy and direct aspiration did not show significant differences. Current available evidence is not sufficient to draw conclusions on the best surgical approach. The combined use of a stent retriever and aspiration as a first-line strategy was associated with higher mTICI 2b/3 and mTICI 3 recanalization rates, although with a higher risk of 24-h SAH, when compared with direct aspiration.
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Affiliation(s)
- Pavlos Texakalidis
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | | | | | | | - Dennis J Rivet
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - John Reavey-Cantwell
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
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Kurz MW, Ospel JM, Advani R, Sandset EC, Aamodt AH, Tennøe B, Ersdal HL, Fjetland L, Ajmi S, Kurz KD, Goyal M. Simulation Methods in Acute Stroke Treatment: Current State of Affairs and Implications. Stroke 2020; 51:1978-1982. [PMID: 32568639 DOI: 10.1161/strokeaha.119.026732] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martin W Kurz
- Department of Neurology (M.W.K., S.A.), Stavanger University Hospital, Norway.,Neuroscience Research Group (M.W.K., R.A., S.A.), Stavanger University Hospital, Norway.,Department of Clinical Science, University of Bergen, Norway (M.W.K.)
| | - Johanna M Ospel
- Department of Clinical Neurosciences (J.M.O.), University of Calgary, Alberta, Canada.,Department of Radiology, Universitätsspital Basel, Switzerland (J.M.O.)
| | - Rajiv Advani
- Neuroscience Research Group (M.W.K., R.A., S.A.), Stavanger University Hospital, Norway.,Department of Neurology, Stroke Unit (R.A., E.C.S.), Oslo University Hospital, Norway
| | - Else Charlotte Sandset
- Department of Neurology, Stroke Unit (R.A., E.C.S.), Oslo University Hospital, Norway.,Department of Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway (E.C.S.)
| | - Anne Hege Aamodt
- Department of Neurology (A.H.A.), Oslo University Hospital, Norway
| | - Bjørn Tennøe
- Department of Radiology and Nuclear Medicine, Division of Diagnostics and Intervention (B.T.), Oslo University Hospital, Norway
| | - Hege L Ersdal
- Department of Anesthesiology and Intensive Care (H.L.E.), Stavanger University Hospital, Norway.,Faculty of Health Sciences (H.L.E.), University of Stavanger, Norway
| | - Lars Fjetland
- Department of Radiology (L.F., K.D.K.), Stavanger University Hospital, Norway.,SMIL Stavanger Medical Imaging Laboratory (L.F., K.D.K.), Stavanger University Hospital, Norway
| | - Soffien Ajmi
- Department of Neurology (M.W.K., S.A.), Stavanger University Hospital, Norway.,Neuroscience Research Group (M.W.K., R.A., S.A.), Stavanger University Hospital, Norway
| | - Kathinka D Kurz
- Department of Radiology (L.F., K.D.K.), Stavanger University Hospital, Norway.,SMIL Stavanger Medical Imaging Laboratory (L.F., K.D.K.), Stavanger University Hospital, Norway.,Department of Electrical and Computer Engineering (K.D.K.), University of Stavanger, Norway
| | - Mayank Goyal
- Diagnostic Imaging (M.G.), University of Calgary, Alberta, Canada.,Department of Clinical Neurosciences (M.G.), University of Calgary, Alberta, Canada
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Wenderoth J, McAuliffe W, Coulthard A, Mitchell P, Arthur A, Fraser JF, McConachie N, Clifton A, Flynn P, Crossley R, Brouwer P, Kulscar Z, Fiehler J. The Role of Interventional Radiologists in Acute Stroke Interventions: A Joint Statement from the Australia and New Zealand Society of Neuroradiology (ANZSNR), the Society of Neurointerventional Surgery (SNIS), the United Kingdom Neurointerventional Group (UKNG), the British Society of Neuroradiology (BSNR), and the European Society for Minimally Invasive, Neurological Therapy (ESMINT). J Vasc Interv Radiol 2019; 30:1400-1403. [DOI: 10.1016/j.jvir.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022] Open
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Sacks D. Interventional Radiologists and Endovascular Therapy for Acute Ischemic Strokes. J Vasc Interv Radiol 2017; 28:1137-1140. [PMID: 28735933 DOI: 10.1016/j.jvir.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/05/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- David Sacks
- Department of Interventional Radiology, Reading Health System, 6th and Spruce Sts., West Reading, PA 19612.
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Behzadi GN, Fjetland L, Advani R, Kurz MW, Kurz KD. Endovascular stroke treatment in a small-volume stroke center. Brain Behav 2017; 7:e00642. [PMID: 28413700 PMCID: PMC5390832 DOI: 10.1002/brb3.642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/29/2016] [Accepted: 12/18/2016] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Our purpose was to evaluate the safety and efficacy of endovascular treatment (EVT) of stroke caused by large vessel occlusions (LVO) performed by general interventional radiologists in cooperation with stroke neurologists and neuroradiologists at a center with a limited annual number of procedures. We aimed to compare our results with those previously reported from larger stroke centers. PATIENTS AND METHODS A total of 108 patients with acute stroke due to LVO treated with EVT were included. Outcome was measured using the modified Rankin scale (mRS) at 90 days. Efficacy was classified according to the modified thrombolysis in cerebral infarction (mTICI) scoring system. Safety was evaluated according to the incidence of procedural complications and symptomatic intracranial hemorrhage (sICH). RESULTS Mean age of the patients was 67.5 years. The median National Institutes of Health Stroke Scale (NIHSS) on hospital admission was 17. Successful revascularization was achieved in 76%. 39.4% experienced a good clinical outcome (mRS<3). Intraprocedural complications were seen in 7.4%. 7.4% suffered a sICH. 21.3% died within 3 months after EVT. DISCUSSION The use of general interventional radiologists in EVT of LVO may be a possible approach for improving EVT coverage where availability of specialized neurointerventionalists is challenging. EVT for LVO stroke performed by general interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists can be safe and efficacious despite the low number of annual procedures.
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Affiliation(s)
- Gry N. Behzadi
- Radiological Research GroupDepartment of RadiologyStavanger University HospitalStavangerNorway
| | - Lars Fjetland
- Radiological Research GroupDepartment of RadiologyStavanger University HospitalStavangerNorway
| | - Rajiv Advani
- Neuroscience Research GroupDepartment of NeurologyStavanger University HospitalStavangerNorway
| | - Martin W. Kurz
- Neuroscience Research GroupDepartment of NeurologyStavanger University HospitalStavangerNorway
| | - Kathinka D. Kurz
- Radiological Research GroupDepartment of RadiologyStavanger University HospitalStavangerNorway
- Stavanger UniversityStavangerNorway
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Wang Q, Duan F, Wang MX, Wang XD, Liu P, Ma LZ. Effect of stem cell-based therapy for ischemic stroke treatment: A meta-analysis. Clin Neurol Neurosurg 2016; 146:1-11. [DOI: 10.1016/j.clineuro.2016.04.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/08/2016] [Accepted: 04/10/2016] [Indexed: 01/01/2023]
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Fjetland L, Kurz KD, Roy S, Kurz MW. Evaluation of the recombinant tissue plasminogen activator pretreatment in acute stroke patients with large vessel occlusions treated with the direct bridging approach. Is it worth the effort? Eur J Neurol 2014; 22:322-7. [DOI: 10.1111/ene.12569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- L. Fjetland
- Department of Radiology; Stavanger University Hospital; Stavanger Norway
- Neuroscience Research Group; Stavanger University Hospital; Stavanger Norway
| | - K. D. Kurz
- Department of Radiology; Stavanger University Hospital; Stavanger Norway
| | - S. Roy
- Department of Radiology; Stavanger University Hospital; Stavanger Norway
| | - M. W. Kurz
- Neuroscience Research Group; Stavanger University Hospital; Stavanger Norway
- Department of Neurology; Stavanger University Hospital; Stavanger Norway
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Birns J, Qureshi S, Chen R, Bhalla A. Endovascular stroke therapy. Eur J Intern Med 2014; 25:584-91. [PMID: 25034389 DOI: 10.1016/j.ejim.2014.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 04/11/2014] [Accepted: 06/26/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Following the development of intravenous thrombolysis as a successful treatment for ischaemic stroke, advances in neurointerventional radiology have facilitated endovascular approaches to treatment. This article reviews the available endovascular therapeutic options and their evidence-base. SUMMARY Initial studies demonstrated that endovascular treatment of ischaemic stroke with intra-arterial thrombolysis and/or the use of clot-retrieval, thrombus aspiration and stent-retriever devices produced early recanalisation and reperfusion and improved neurological outcome. More recent randomised trials, however, have failed to show translation of recanalisation into successful clinical outcome with 'time to treatment' proving crucial. In this rapidly evolving field, combined therapy incorporating intravenous and intra-arterial thrombolysis in combination with endovascular clot-retrieval has been developed and further studies are expected to yield better evidence to guide the optimal treatment of acute cerebral ischaemia.
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Affiliation(s)
- Jonathan Birns
- Department of Ageing & Health, St Thomas' Hospital, London, United Kingdom; Department of Stroke Medicine, King's College Hospital, London, United Kingdom.
| | - Sam Qureshi
- Department of Ageing & Health, St Thomas' Hospital, London, United Kingdom; Department of Stroke Medicine, King's College Hospital, London, United Kingdom
| | - Ruoling Chen
- Department of Health and Social Care Research, King's College London, London, United Kingdom
| | - Ajay Bhalla
- Department of Ageing & Health, St Thomas' Hospital, London, United Kingdom; Department of Stroke Medicine, King's College Hospital, London, United Kingdom; Department of Health and Social Care Research, King's College London, London, United Kingdom
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11
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Logallo N, Kvistad CE, Nacu A, Naess H, Waje-Andreassen U, Asmuss J, Aamodt AH, Lund C, Kurz MW, Rønning OM, Salvesen R, Idicula TT, Thomassen L. The Norwegian tenecteplase stroke trial (NOR-TEST): randomised controlled trial of tenecteplase vs. alteplase in acute ischaemic stroke. BMC Neurol 2014; 14:106. [PMID: 24886064 PMCID: PMC4029902 DOI: 10.1186/1471-2377-14-106] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/23/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Alteplase is the only approved thrombolytic agent for acute ischaemic stroke. The overall benefit from alteplase is substantial, but some evidence indicates that alteplase also has negative effects on the ischaemic brain. Tenecteplase may be more effective and less harmfull than alteplase, but large randomised controlled phase 3 trials are lacking. The Norwegian Tenecteplase Stroke Trial (NOR-TEST) aims to compare efficacy and safety of tenecteplase vs. alteplase. METHODS/DESIGN NOR-TEST is a multi-centre PROBE (prospective randomised, open-label, blinded endpoint) trial designed to establish superiority of tenecteplase 0.4 mg/kg (single bolus) as compared with alteplase 0.9 mg/kg (10% bolus + 90% infusion/60 minutes) for consecutively admitted patients with acute ischaemic stroke eligible for thrombolytic therapy, i.e. patients a) admitted <4½ hours after symptoms onset; b) admitted <4½ hours after awakening with stroke symptoms c) receiving bridging therapy before embolectomy.Randomisation tenecteplase:alteplase is 1:1. The primary study endpoint is favourable functional outcome defined as modified Rankin Scale 0-1 at 90 days. Secondary study endpoints are: 1) haemorrhagic transformation (haemorrhagic infarct/haematoma); 2) symptomatic cerebral haemorrhage on CT 24-48 hours; 3) major neurological improvement at 24 hours; 4) recanalisation at 24-36 hours; 5) death. DISCUSSION NOR-TEST may establish a novel approach to acute ischaemic stroke treatment. A positive result will lead to a more effective, safer and easier treatment for all acute ischaemic stroke pasients.NOR-TEST is reviewed and approved by the Regional Committee for Medical and Health Research Ethics (2011/2435), and The Norwegian Medicines Agency (12/01402). NOR-TEST is registered with EudraCT No 2011-005793-33 and in ClinicalTrials.gov (NCT01949948).
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Affiliation(s)
- Nicola Logallo
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christopher E Kvistad
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Aliona Nacu
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Halvor Naess
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Ulrike Waje-Andreassen
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jörg Asmuss
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway
| | - Christian Lund
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway
| | - Martin W Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Ole Morten Rønning
- Medical Division, Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Rolf Salvesen
- Department of Neurology, Nordland Hospital, Bodo, Norway
- Department of Clinical Medicine, University of Tromso, Norway
| | - Titto T Idicula
- Department of Neurology, St.Olav Hospital, Trondheim, Norway
| | - Lars Thomassen
- Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Gandini R, Del Giudice C, Chegai F, Konda D, Sallustio F, Pampana E, Stefanini M, Spinelli A, Fabiano S, Reale CA, Stanzione P, Simonetti G. Encouraging and positive trend towards treatment of acute ischemic stroke performed by vascular interventional radiologist. Cardiovasc Intervent Radiol 2014; 37:1384-6. [PMID: 24595659 DOI: 10.1007/s00270-014-0860-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/24/2013] [Indexed: 01/19/2023]
Affiliation(s)
- Roberto Gandini
- Department of Imaging Diagnostic, Molecular Imaging, Interventional Radiology and Radiation Therapy, IRCCS Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
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Fjetland L, Kurz MW. Encouraging and positive trend towards treatment of acute ischemic stroke performed by vascular interventional radiologist: reply. Cardiovasc Intervent Radiol 2014; 37:1387-8. [PMID: 24556830 DOI: 10.1007/s00270-014-0863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/01/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Lars Fjetland
- Department of Radiology, Stavanger University Hospital, Postboks 8100, 4068, Stavanger, Norway,
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Fjetland L, Roy S, Kurz KD, Solbakken T, Larsen JP, Kurz MW. Neurointerventional treatment in acute stroke. Whom to treat? (Endovascular treatment for acute stroke: utility of THRIVE score and HIAT score for patient selection). Cardiovasc Intervent Radiol 2013; 36:1241-6. [PMID: 23665859 DOI: 10.1007/s00270-013-0636-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Intra-arterial therapy (IAT) is used increasingly as a treatment option for acute stroke caused by central large vessel occlusions. Despite high rates of recanalization, the clinical outcome is highly variable. The authors evaluated the Houston IAT (HIAT) and the totaled health risks in vascular events (THRIVE) score, two predicting scores designed to identify patients likely to benefit from IAT. METHODS Fifty-two patients treated at the Stavanger University Hospital with IAT from May 2009 to June 2012 were included in this study. We combined the scores in an additional analysis. We also performed an additional analysis according to high age and evaluated the scores in respect of technical efficacy. RESULTS Fifty-two patients were evaluated by the THRIVE score and 51 by the HIAT score. We found a strong correlation between the level of predicted risk and the actual clinical outcome (THRIVE p = 0.002, HIAT p = 0.003). The correlations were limited to patients successfully recanalized and to patients <80 years. By combining the scores additional 14.3 % of the patients could be identified as poor candidates for IAT. Both scores were insufficient to identify patients with a good clinical outcome. CONCLUSIONS Both scores showed a strong correlation to poor clinical outcome in patients <80 years. The specificity of the scores could be enhanced by combining them. Both scores were insufficient to identify patients with a good clinical outcome and showed no association to clinical outcome in patients aged ≥80 years.
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Affiliation(s)
- Lars Fjetland
- Department of Radiology, Stavanger University Hospital, 4068, Stavanger, Norway,
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