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J Neurointerv Surg. 2018 Aug;10(8):741-745. doi: 10.1136/neurintsurg-2017-013534. Epub 2017 Nov 16.

Mechanical thrombectomy performs similarly in real world practice: a 2016 nationwide study from the Czech Republic.

Author information

1
Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
2
International Clinical Research Centre, Stroke Research Program, St Anne's University Hospital, Brno, Czech Republic.
3
Department of Radiology, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic.
4
Department of Neurology, University Hospital Ostrava, Faculty of Medicine, University Ostrava, Ostrava, Czech Republic.
5
Department of Medical Imaging, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
6
Department of Neurology, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic.
7
Department of Neurology, Palacky University Medical School, Olomouc, Czech Republic.
8
Department of Neurology, Charles University, 2nd Medical Faculty, Prague, Czech Republic.
9
Department of Radiology, University Hospital and Palacky, University Medical School, Olomouc, Czech Republic.
10
Department of Radiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Usti nad Labem, Czech Republic.
11
Department of Radiology, Masaryk Hospital, Usti nad Labem, Czech Republic.
12
Department of Neurology, Hospital Ceske Budejovice, Statutory City, Czech Republic.
13
Neurocentre, Regional Hospital Liberec, Liberec, Czech Republic.
14
Department of Neurology, Military University Hospital, Prague, Canada.
15
Department of Neurology, Na Homolce Hospital, Prague, Czech Republic.
16
Department of Neurology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
17
Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic.
18
Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.

Abstract

BACKGROUND:

Randomized clinical trials have proven mechanical thrombectomy (MT) to be a highly effective and safe treatment in acute stroke. The purpose of this study was to compare neurothrombectomy data from the Czech Republic (CR) with data from the HERMES meta-analysis.

METHODS:

Available nationwide data for the CR from 2016 from the Safe Implementation of Treatments in Stroke-Thrombectomy (SITS-TBY) registry for patients with terminal internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusions were compared with data from HERMES. CR and HERMES patients were comparable in age, sex, and baseline National Institutes of Health Stroke Scale scores.

RESULTS:

From a total of 1053 MTs performed in the CR, 845 (80%) were reported in the SITS-TBY. From these, 604 (72%) were included in this study. Occlusion locations were as follows (CR vs HERMES): ICA 22% versus 21% (P=0.16), M1 MCA 62% versus 69% (P=0.004), and M2 MCA 16% versus 8% (P<0.0001). Intravenous thrombolysis was given to 76% versus 83% of patients, respectively (P=0.003). Median onset to reperfusion times were comparable: 232 versus 285 min, respectively (P=0.66). A modified Thrombolysis in Cerebral Infarction score of 2b/3 was achieved in 74% (433/584) versus 71% (390/549) of patients, respectively (OR 1.17, 95% CI 0.90-1.5, P=0.24). There was no statistically significant difference in the percentage of parenchymalhematoma type 2 (OR 1.12, 95% CI 0.66-1.90, P=0.68). A modified Rankin Scale score of 0-2 at 3 months was achieved in 48% (184/268) versus 46% (291/633) of patients, respectively (OR 0.92, 95% CI 0.71-1.18, P=0.48).

CONCLUSIONS:

Data on efficacy, safety, and logistics of MT from the CR were similar to data from the HERMES collaboration.

KEYWORDS:

stroke; thrombectomy

PMID:
29146830
DOI:
10.1136/neurintsurg-2017-013534
[Indexed for MEDLINE]

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