Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Endovascular treatment results in patients with large cerebral artery occlusions in a metropolis. Moscow Stroke Registry data over 2019

https://doi.org/10.14412/2074-2711-2020-5-9-17

Full Text:

Abstract

Objective: to assess results from the Stroke Network created on the basis of the Infarction Network in the metropolis Moscow for endovascular treatment in patients with occlusion of the large cerebral artery (the internal carotid artery, the M1 and M2 segments of the middle cerebral artery, and the main artery).

Patients and methods. A total of 742 thromboextractions were performed in patients with ischemic stroke in Moscow Stroke Network hospitals in 2019. The final analysis included 729 patients aged 25 to 97 years (mean age, 71 years); of them there were 370 (50.8%) men and 359 (49.2%) women. The selection criteria for endovascular treatment for ischemic stroke were consistent with those set out in the 2015 American Heart Association/American Stroke Association (AHA/ASA) guidelines, which included a pre-stroke modified Rankin Scale (MRS) score of 0–1; ≥18 years of age; a National Institutes of Health Stroke Scale (NIHSS) score of ≥6; and an Alberta Stroke Programme Early CT score (ASPECTS) ≥6. The angiographic results were assessed using the Thrombolysis in Cerebral Infarction (TICI) scale. The clinical outcomes were measured with the NIHSS and the MRS.

Results and discussion. Successful recanalization (TICI 2b/3) was achieved in 547 (75%) patients. The predominant technique for thromboextraction was thromboaspiration that was used in 376 (51.6%) patients. Combined procedures (the co-use of an aspiration catheter and a stent retriever) were the second most commonly used – in 231 (31.7%) patients. By the end of the 20th day, good functional recovery (MSR 0–2 scores) was observed in 213 (29.2%) patients. The 20-day mortality rate was 31.8%.

Conclusion. The successfully functioning Infarction Network in Moscow was used to create the Stroke Network for treatment in patients with ischemic stroke and large cerebral artery occlusion, the clinical results of which are comparable to large European registry studies.

About the Authors

D. V. Skrypnik
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia; I.V. Davydovsky City Clinical Hospital, Moscow Healthcare Department
Russian Federation

Dmitry V. Skrypnik

20, Delegatskaya St., Build. 1, Moscow 127473,

11, Yauzskaya St., Moscow 109240




K. V. Anisimov
I.V. Davydovsky City Clinical Hospital, Moscow Healthcare Department
Russian Federation

11, Yauzskaya St., Moscow 109240



A. Yu. Botsina
I.V. Davydovsky City Clinical Hospital, Moscow Healthcare Department
Russian Federation

11, Yauzskaya St., Moscow 109240



T. V. Kiseleva
Federal Center of Brain and Neurotechnologies, Federal Biomedical Agency
Russian Federation

1, Ostrovityanov St., Build. 10, Moscow 117997



S. P. Grachev
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia; I.V. Davydovsky City Clinical Hospital, Moscow Healthcare Department
Russian Federation

20, Delegatskaya St., Build. 1, Moscow 127473,

11, Yauzskaya St., Moscow 109240



N. A. Shamalov
Federal Center of Brain and Neurotechnologies, Federal Biomedical Agency
Russian Federation

1, Ostrovityanov St., Build. 10, Moscow 117997



E. Yu. Vasilyeva
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia; I.V. Davydovsky City Clinical Hospital, Moscow Healthcare Department
Russian Federation

20, Delegatskaya St., Build. 1, Moscow 127473,

11, Yauzskaya St., Moscow 109240



A. V. Shpektor
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia; I.V. Davydovsky City Clinical Hospital, Moscow Healthcare Department
Russian Federation

20, Delegatskaya St., Build. 1, Moscow 127473,

11, Yauzskaya St., Moscow 109240



References

1. Volodyukhin MYu. Intra-arterial reperfusion therapy in patients with acute ischemic stroke. Meditsinskiy sovet. 2015;(10):4-5 (In Russ.).

2. Krylov VV, Volodyukhin MYu. Organization of interventional surgery for patients with acute ischemic stroke. Neyrokhirurgiya = Russian Journal of Neurosurgery. 2017;(2):60-5 (In Russ.).

3. Savello AV, Svistov DV. Endovascular interventions in acute stroke: last randomized controlled trials review and practical perspectives. Endovaskulyarnaya khirurgiya = Russian Journal of Endovascular Surgery. 2015; 2(3):15-23 (In Russ.).

4. Anisimov KV, Manchurov VN, Skrypnik DV, et al. Technical aspects of endovascular treatment for ischemic stroke. Endovaskulyarnaya khirurgiya = Russian Journal of Endovascular Surgery. 2018;5(1):30-42. doi: 10.24183/2409-4080-2018-5-1-30-42 (In Russ.).

5. Saver JL. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015 Jun 11;372(24):2285-95. doi: 10.1056/NEJMoa1415061. Epub 2015 Apr 17.

6. Jovin TG. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015 Jun 11;372(24):2296-306. doi: 10.1056/NEJMoa1503780. Epub 2015 Apr 17.

7. Goyal M. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015 Mar 12;372(11):1019-30. doi: 10.1056/NEJMoa1414905. Epub 2015 Feb 11.

8. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015 Mar 12;372(11):1009-18. doi: 10.1056/NEJMoa1414792. Epub 2015 Feb 11.

9. Berkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 Jan 1;372(1):11-20. doi: 10.1056/NEJMoa1411587. Epub 2014 Dec 17.

10. Silverman IE, Beland DK, Chhabra J, McCullough LD. The «drip-and-ship» approach: starting IV t-PA for acute ischemic stroke at outside hospitals prior to transfer to a regional stroke center. Conn Med. Nov-Dec 2005;69(10):613-20.

11. Ismail M, Armoiry X, Tau N, et al. Mothership versus drip and ship for thrombectomy in patients who had an acute stroke: a systematic review and meta-analysis. J Neurointerv Surg. 2019 Jan;11(1):14-9. doi: 10.1136/neurintsurg-2018-014249. Epub 2018 Oct 8.

12. Brekenfeld C, Goebell E, Schmidt H, et al. 'Drip-and-drive': shipping the neurointerventionalist to provide mechanical thrombectomy in primary stroke centers. J Neurointerv Surg. 2018 Oct;10(10):932-6. doi: 10.1136/neurintsurg-2017-013634. Epub 2018 Feb 7.

13. Hastrup S, Damgaard D, Paaske Johnsen S, Andersen G. Prehospital Acute Stroke Severity Scale to Predict Large Artery Occlusion: Design and Comparison With Other Scales. Stroke. 2016 Jul;47(7):1772-6. doi: 10.1161/STROKEAHA.115.012482. Epub 2016 Jun 7.

14. Kidwell CS, Starkman S, Eckstein M, et al. Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke. 2000 Jan;31(1):71-6. doi: 10.1161/01.str.31.1.71

15. Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015 Oct;46(10):3020-35. doi: 10.1161/STR.0000000000000074. Epub 2015 Jun 29.

16. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018 Feb 22;378(8):708-18. doi: 10.1056/NEJMoa1713973. Epub 2018 Jan 24.

17. Nogueira RG, Jadhav AP, Haussen DC, et al. for the DAWN Trial Investigators, Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018 Jan 4;378(1):11-21. doi: 10.1056/NEJMoa1706442. Epub 2017 Nov 11.

18. Holmes DR, Hopkins LN. Interventional Cardiology and Acute Stroke Care Going Forward: JACC Review Topic of the Week. J Am Coll Cardiol. 2019 Apr 2;73(12):1483-90. doi: 10.1016/j.jacc.2019.01.033

19. Widimsky P. Thrombectomy for stroke by cardiologists. Eur Heart J. 2018 Sep 1;39(33):3018. doi: 10.1093/eurheartj/ehy442

20. Adeoye O, Albright KC, Carr BG, et al. Geographic access to acute stroke care in the United States. Stroke. 2014 Oct;45(10):3019-24. doi: 10.1161/STROKEAHA.114.006293. Epub 2014 Aug 26.

21. White CJ. Acute Stroke Intervention: The Role of Interventional Cardiologists. J Am Coll Cardiol. 2019 Apr 2;73(12):1491-3. doi: 10.1016/j.jacc.2018.12.071

22. Meng SW, Kuo RC, Yang HJ, et al. Recruiting an Acute Coronary Team to Perform Emergent Mechanical Thrombectomy in Acute Ischemic Stroke Patients: A Successful Case and Team Model in a Local Hospital. Acta Cardiol Sin. 2018 Jan;34(1):99-103. doi: 10.6515/ACS.201801_34(1).20170730A

23. Petr W, Koznar B, Peisker T, et al. Feasibility and safety of direct catheter-based thrombectomy in the treatment of acute ischaemic stroke. Cooperation among cardiologists, neurologists and radiologists. Prospective registry PRAGUE-16. EuroIntervention. 2017;13(1):131-6. doi: 10.4244/EIJ-D-16-00979

24. Guidera SA, Aggarwal S, Walton JD, et al. Mechanical Thrombectomy for Acute Ischemic Stroke in the Cardiac Catheterization Laboratory. JACC Cardiovasc Interv. 2020 Apr 13;13(7):884-91. doi: 10.1016/j.jcin.2020.01.232

25. Kim BM, Baek JH, Heo JH, et al. Effect of Cumulative Case Volume on Procedural and Clinical Outcomes in Endovascular Thrombectomy. Stroke. 2019 May;50(5):1178- 83. doi: 10.1161/STROKEAHA.119.024986

26. Nikoubashman O, Pauli F, Schürmann K, et al. Transfer of stroke patients impairs eligibility for endovascular stroke treatment. J Neuroradiol. 2018 Feb;45(1):49-53. doi: 10.1016/j.neurad.2017.07.006. Epub 2017 Sep 18.

27. Froehler MT, Saver JL, Zaidat OO, et al. Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke). Circulation. 2017;136(24):2311-21. doi: 10.1161/CIRCULATIONAHA.117.028920

28. McMeekin P, White P, James MA, et al. Estimating the number of UK stroke patients eligible for endovascular thrombectomy. Eur Stroke J. 2017 Dec;2(4):319-26. doi: 10.1177/2396987317733343. Epub 2017 Oct 4.

29. Chia NH, Leyden JM, Newbury J, et al. Determining the Number of Ischemic Strokes Potentially Eligible for Endovascular Thrombectomy: A Population-Based Study. Stroke. 2016 May;47(5):1377-80. doi: 10.1161/STROKEAHA.116.013165. Epub 2016 Mar 17.

30. Alegiani AC, Dorn F, Herzberg M, et al. Systematic evaluation of stroke thrombectomy in clinical practice: The German Stroke Registry Endovascular Treatment. Int J Stroke. 2019 Jun;14(4):372-80. doi: 10.1177/1747493018806199. Epub 2018 Oct 22.

31. Deb-Chatterji M, Pinnschmidt H, Flottmann F, et al. Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study. BMC Neurol. 2020 Mar 5;20(1):81. doi: 10.1186/s12883-020-01653-z

32. Jansen IGH, Mulder MJHL, Goldhoorn R-JB; MR CLEAN Registry investigators. Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry). BMJ. 2018 Mar 9;360:k949. doi: 10.1136/bmj.k949

33. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016 Apr 23;387(10029):1723-31. doi: 10.1016/S0140-6736(16)00163-X. Epub 2016 Feb 18.

34. Goyal M, Simonsen CZ, Fisher M. Future trials on endovascular stroke treatment: the not-so-easy-to-pluck fruits. Neuroradiology. 2018 Feb;60(2):123-6. doi: 10.1007/s00234-017-1966-0


For citation:


Skrypnik D.V., Anisimov K.V., Botsina A.Yu., Kiseleva T.V., Grachev S.P., Shamalov N.A., Vasilyeva E.Yu., Shpektor A.V. Endovascular treatment results in patients with large cerebral artery occlusions in a metropolis. Moscow Stroke Registry data over 2019 Neurology, Neuropsychiatry, Psychosomatics. 2020;12(5):9-17. https://doi.org/10.14412/2074-2711-2020-5-9-17

Views: 62


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)