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Neurointervention. 2018 Mar;13(1):2-12. doi: 10.5469/neuroint.2018.13.1.2. Epub 2018 Mar 2.

Temporal Changes in Care Processes and Outcomes for Endovascular Treatment of Acute Ischemic Stroke: Retrospective Registry Data from Three Korean Centers.

Author information

1
Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.
2
Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.
3
Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
4
Department of Radiology, Keimyung University Dongsan Medical Center, Daegu, Korea.
5
Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea.
6
Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.
7
Department of Radiology, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.
8
Department of Neurosurgery, Kyungpook National University School of Medicine and Hospital, Daegu, Korea.
9
Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
10
Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada.

Abstract

Background and Purpose:

The purpose of the current study is to evaluate the influence of temporal patterns related to the availability of new endovascular treatment (EVT) devices on care processes and outcomes among patients with AIS.

Materials and Methods:

We enrolled 720 consecutive patients (January 2011 to May 2016) in a retrospective registry, ASIAN KR, from three Korean hospitals, who received EVT for acute ischemic stroke (AIS) caused by cervicocephalic arterial occlusions. We performed period-to-period analyses based on stent retriever reimbursement and the availability of second-generation direct-aspiration devices (Period 1: January 2011-July 2014 vs. Period 2: August 2014-May 2016); time metrics and outcomes were compared when the onset-to-puncture time was <720 min among patients with EVT for intracranial occlusion.

Results:

Period 2 had better post-EVT outcomes (3-month modified Rankin Scale 0-2 or equal to prestroke score, 48.3% vs. 60.2%, P=0.004), more successful reperfusion rates (modified Treatment In Cerebral Ischemia 2b-3, 74.2% vs. 82.2%, P=0.019), fewer subarachnoid hemorrhages (modified Fisher grade 3-4, 5.5% vs. 2.0%, P=0.034) and lower hemorrhagic transformation rates (any intracerebral hemorrhage, 35.3 vs. 22.7%, P=0.001) than Period 1. Compared to Period 1, Period 2 had a shorter door-to-puncture time (median 109 vs. 90 min, P<0.001), but longer onset-to-door time (129 vs. 143 min, P=0.057).

Conclusion:

Recent temporal improvements in post-EVT AIS outcomes in Korea are likely due to a combination of enhanced hospital care processes and administration of newer thrombectomy devices.

KEYWORDS:

Cerebral hemorrhage; Cerebral infarction; Learning curve; Reperfusion; Thrombectomy; Treatment outcome

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