Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke: Primary Results of the STRATIS Registry
Nils Mueller-Kronast,Osama O. Zaidat,Michael T. Froehler,Reza Jahan,Mohammad Ali Aziz-Sultan,Richard P. Klucznik,Jeffrey L. Saver,Frank R Hellinger,Dileep R. Yavagal,Tom L. Yao,David S Liebeskind,Ashutosh P Jadhav,Rishi Gupta,Ameer E Hassan,Coleman O. Martin,Hormozd Bozorgchami,Ritesh Kaushal,Raul G Nogueira,Ravi H. Gandhi,Eric C. Peterson,Shervin R. Dashti,Curtis A. Given,Brijesh P Mehta,Vivek R. Deshmukh,Sidney Starkman,Italo Linfante,Scott H. McPherson,Peter Kvamme,Thomas Grobelny,Muhammad S Hussain,Ike Thacker,Nirav Vora,Peng R Chen,Stephen J. Monteith,Robert D. Ecker,Clemens M. Schirmer,Eric Sauvageau,Alex Abou-Chebl,Colin P. Derdeyn,Lucian Maidan,Aamir Badruddin,Adnan H. Siddiqui,Travis M. Dumont,Abdulnasser Alhajeri,M. Asif Taqi,Khaled Asi,Jeffrey S Carpenter,Alan S. Boulos,Gaurav Jindal,Ajit S. Puri,Rohan Chitale,Eric M. Deshaies,David H. Robinson,David F. Kallmes,Blaise Baxter,Mouhammad A. Jumaa,Peter Sunenshine,Aniel Q. Majjhoo,Joey English,Shuichi Suzuki,Richard D. Fessler,Josser E Delgado Almandoz,Jerry C. Martin,Diogo C Haussen +63 more
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This largest-to-date Solitaire registry documents that the results of the randomized trials can be reproduced in the community and the decrease of clinical benefit over time warrants optimization of the system of care.Abstract:
Background and Purpose— Mechanical thrombectomy with stent retrievers has become standard of care for treatment of acute ischemic stroke patients because of large vessel occlusion. The STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) aimed to assess whether similar process timelines, technical, and functional outcomes could be achieved in a large real world cohort as in the randomized trials. Methods— STRATIS was designed to prospectively enroll patients treated in the United States with a Solitaire Revascularization Device and Mindframe Capture Low Profile Revascularization Device within 8 hours from symptom onset. The STRATIS cohort was compared with the interventional cohort of a previously published SEER patient-level meta-analysis. Results— A total of 984 patients treated at 55 sites were analyzed. The mean National Institutes of Health Stroke Scale score was 17.3. Intravenous tissue-type plasminogen activator was administered in 64.0%. The median time from onset to arrival in the enrolling hospital, door to puncture, and puncture to reperfusion were 138, 72, and 36 minutes, respectively. The Core lab–adjudicated modified Thrombolysis in Cerebral Infarction ≥2b was achieved in 87.9% of patients. At 90 days, 56.5% achieved a modified Rankin Scale score of 0 to 2, all-cause mortality was 14.4%, and 1.4% suffered a symptomatic intracranial hemorrhage. The median time from emergency medical services scene arrival to puncture was 152 minutes, and each hour delay in this interval was associated with a 5.5% absolute decline in the likelihood of achieving modified Rankin Scale score 0 to 2. Conclusions— This largest-to-date Solitaire registry documents that the results of the randomized trials can be reproduced in the community. The decrease of clinical benefit over time warrants optimization of the system of care. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02239640.read more
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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)
TL;DR: Endovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-depen...
Journal ArticleDOI
Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry)
TL;DR: In routine clinical practice, endovascular treatment for patients with acute ischaemic stroke is at least as effective and safe as in the setting of a randomised controlled trial.
Journal ArticleDOI
Association Between Time to Treatment With Endovascular Reperfusion Therapy and Outcomes in Patients With Acute Ischemic Stroke Treated in Clinical Practice
Reza Jahan,Jeffrey L. Saver,Lee H. Schwamm,Gregg C. Fonarow,Li Liang,Roland A. Matsouaka,Ying Xian,Da Juanicia N. Holmes,Eric D. Peterson,Dileep R. Yavagal,Eric E. Smith +10 more
TL;DR: Among patients with AIS due to large vessel occlusion treated in routine clinical practice, shorter time to endovascular-reperfusion therapy was significantly associated with better outcomes, and these findings support efforts to reduce time to hospital and endov vascular treatment in patients with stroke.
Journal ArticleDOI
Functional Outcome Following Stroke Thrombectomy in Clinical Practice
Frank A. Wollenweber,Steffen Tiedt,Anna Alegiani,Burkhard Alber,Christopher Bangard,Jörg Berrouschot,Felix J. Bode,Tobias Boeckh-Behrens,Georg Bohner,Albrecht Bormann,Michael Braun,Franziska Dorn,Bernd Eckert,Fabian Flottmann,Gerhard F. Hamann,Karl-Heinz Henn,Moriz Herzberg,Andreas Kastrup,Lars Kellert,Christoffer Kraemer,Lars Udo Krause,Manuel Lehm,Jan Liman,Stephan Lowens,Anastasios Mpotsaris,Panagiotis Papanagiotou,Martina Petersen,Gabor C. Petzold,Gabor C. Petzold,Waltraud Pfeilschifter,Marios-Nikos Psychogios,Arno Reich,Regina von Rennenberg,Joachim Röther,Jan-Hendrik Schäfer,Eberhard Siebert,Andreas Siedow,Laszlo Solymosi,Sven Thonke,Marlies Wagner,Silke Wunderlich,Sarah Zweynert,Christian H. Nolte,Christian Gerloff,Götz Thomalla,Martin Dichgans,Martin Dichgans,Jens Fiehler +47 more
TL;DR: Mortality appears to be greater in the daily routine than otherwise reported by authors of large randomized trials and high rates of favorable outcome can be achieved on a countrywide scale by endovascular treatment.
Journal ArticleDOI
Time to Endovascular Treatment and Outcome in Acute Ischemic Stroke: MR CLEAN Registry Results
Maxim J. H. L. Mulder,Ivo G. H. Jansen,Robert-Jan B. Goldhoorn,Esmee Venema,Vicky Chalos,Kars C.J. Compagne,Bob Roozenbeek,Hester F. Lingsma,Wouter J. Schonewille,Ido R. van den Wijngaard,Jelis Boiten,Jan Albert Vos,Yvo B.W.E.M. Roos,Robert J. van Oostenbrugge,Wim H. van Zwam,Charles B. L. M. Majoie,Aad van der Lugt,Diederik W.J. Dippel +17 more
TL;DR: Time to EVT for acute ischemic stroke in current clinical practice is strongly associated with functional outcome, and the data suggest that this association might be even stronger than previously suggested in reports on more selected patient populations from randomized, controlled trials.
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TL;DR: In patients with ischemic stroke with a proximal cerebral arterial occlusion and salvageable tissue on CT perfusion imaging, early thrombectomy with the Solitaire FR stent retriever, as compared with alteplase alone, improved reperfusion, early neurologic recovery, and functional outcome.
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Jeffrey L. Saver,Mayank Goyal,Alain Bonafe,Hans-Christoph Diener,Elad I. Levy,Vitor Mendes Pereira,Gregory W. Albers,Christophe Cognard,David J. Cohen,Werner Hacke,Olav Jansen,Tudor G Jovin,Heinrich Mattle,Raul G Nogueira,Adnan H. Siddiqui,Dileep R. Yavagal,Blaise Baxter,Thomas Devlin,Demetrius K. Lopes,Vivek Y. Reddy,Richard du Mesnil de Rochemont,Oliver C. Singer,Reza Jahan +22 more
TL;DR: In patients receiving intravenous t-PA for acute ischemic stroke, thrombectomy with the use of a stent retriever within 6 hours after onset improved functional outcomes at 90 days.
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