Time trends in mechanical thrombectomy (2017–2021): do real-world data reflect advances in evidence?
BackgroundIn recent years, we have witnessed a continuous, evidence-based expansion of indications for endovascular therapy (EVT) in the treatment of ischaemic stroke, driven by advancements in extended time windows and target vessel occlusion. Our study aimed to evaluate the temporal changes in pat...
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Frontiers Media S.A.
2025-02-01
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| author | Christoph Riegler Christoph Riegler Viktoria Rücker Regina von Rennenberg Regina von Rennenberg Kerstin Bollweg Kerstin Bollweg Bastian Cheng Anna C. Alegiani Fabian Flottmann Marlena Schnieder Marielle Ernst Waltraud Pfeilschifter Waltraud Pfeilschifter Waltraud Pfeilschifter Christoffer Kraemer Ruben Mühl-Benninghaus Steffen Tiedt Steffen Tiedt Lars Kellert Hanna Zimmermann Felix J. Bode Felix J. Bode Gabor C. Petzold Gabor C. Petzold Franziska Dorn Jörg Berrouschot Albrecht Bormann Kathleen Bernkopf Silke Wunderlich Tobias Boeckh-Behrens Martina Petersen Lars Udo Krause Stephan Lowens Heinrich J. Audebert Heinrich J. Audebert Eberhard Siebert Peter U. Heuschmann Peter U. Heuschmann Peter U. Heuschmann Christian H. Nolte Christian H. Nolte Christian H. Nolte Christian H. Nolte |
| author_facet | Christoph Riegler Christoph Riegler Viktoria Rücker Regina von Rennenberg Regina von Rennenberg Kerstin Bollweg Kerstin Bollweg Bastian Cheng Anna C. Alegiani Fabian Flottmann Marlena Schnieder Marielle Ernst Waltraud Pfeilschifter Waltraud Pfeilschifter Waltraud Pfeilschifter Christoffer Kraemer Ruben Mühl-Benninghaus Steffen Tiedt Steffen Tiedt Lars Kellert Hanna Zimmermann Felix J. Bode Felix J. Bode Gabor C. Petzold Gabor C. Petzold Franziska Dorn Jörg Berrouschot Albrecht Bormann Kathleen Bernkopf Silke Wunderlich Tobias Boeckh-Behrens Martina Petersen Lars Udo Krause Stephan Lowens Heinrich J. Audebert Heinrich J. Audebert Eberhard Siebert Peter U. Heuschmann Peter U. Heuschmann Peter U. Heuschmann Christian H. Nolte Christian H. Nolte Christian H. Nolte Christian H. Nolte |
| author_sort | Christoph Riegler |
| collection | DOAJ |
| description | BackgroundIn recent years, we have witnessed a continuous, evidence-based expansion of indications for endovascular therapy (EVT) in the treatment of ischaemic stroke, driven by advancements in extended time windows and target vessel occlusion. Our study aimed to evaluate the temporal changes in patients’ characteristics, treatment, and outcomes in clinical practice.MethodsWe used data from the German Stroke Registry, a large national multicentre prospective registry, which includes all patients receiving EVT for ischaemic stroke at its participating centers. We analysed baseline factors, treatment details, and clinical outcomes [Modified Rankin Scale (mRS) at 3 months] over a 5-year period (2017–2021).ResultsWe included 6,251 patients from eight centres. Over time, the characteristics of patients undergoing EVT changed in several aspects (2017 vs. 2021). Patients became older (median age from 76 [IQR: 65–82] to 77 [65–84 years]; ptrend = 0.02), and less severely affected (NIHSS from 15 [11–19] to 13 [8–18]; ptrend <0.001). There was an increase in patients treated more than 6 h after last seen well (22.0% to 28.3%; ptrend<0.001), and more patients were treated for medium vessel occlusion (16.1% to 28.1%; ptrend<0.001). The use of intravenous thrombolysis decreased (52.4% to 40.4%; ptrend<0.01). Good functional outcome declined (percentage of patients with mRS ≤ 2 from 36.0 to 34.9%; aOR 0.94 per year [0.89–0.99]), while mortality at 3 months increased from 25.3% in 2017 to 34.7% in 2021; aOR 1.13 per year [1.07–1.19].ConclusionBetween 2017 and 2021, there were significant shifts in the demographic and clinical profiles of patients undergoing EVT, along with an expansion in EVT indications. Despite these patients presenting with less severe stroke symptoms, improvements in functional outcomes were not observed, and mortality rates increased. These trends may reflect willingness to treat patients with more severe underlying health conditions. |
| format | Article |
| id | doaj-art-258e086f07e6459bb8ea4f2c8990f358 |
| institution | Kabale University |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-02-01 |
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| series | Frontiers in Neurology |
| spelling | doaj-art-258e086f07e6459bb8ea4f2c8990f3582025-02-11T05:10:20ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-02-011510.3389/fneur.2024.15172761517276Time trends in mechanical thrombectomy (2017–2021): do real-world data reflect advances in evidence?Christoph Riegler0Christoph Riegler1Viktoria Rücker2Regina von Rennenberg3Regina von Rennenberg4Kerstin Bollweg5Kerstin Bollweg6Bastian Cheng7Anna C. Alegiani8Fabian Flottmann9Marlena Schnieder10Marielle Ernst11Waltraud Pfeilschifter12Waltraud Pfeilschifter13Waltraud Pfeilschifter14Christoffer Kraemer15Ruben Mühl-Benninghaus16Steffen Tiedt17Steffen Tiedt18Lars Kellert19Hanna Zimmermann20Felix J. Bode21Felix J. Bode22Gabor C. Petzold23Gabor C. Petzold24Franziska Dorn25Jörg Berrouschot26Albrecht Bormann27Kathleen Bernkopf28Silke Wunderlich29Tobias Boeckh-Behrens30Martina Petersen31Lars Udo Krause32Stephan Lowens33Heinrich J. Audebert34Heinrich J. Audebert35Eberhard Siebert36Peter U. Heuschmann37Peter U. Heuschmann38Peter U. Heuschmann39Christian H. Nolte40Christian H. Nolte41Christian H. Nolte42Christian H. Nolte43Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, GermanyCenter for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, GermanyInstitute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, GermanyDepartment of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, GermanyCenter for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, GermanyDepartment of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, GermanyCenter for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, GermanyDepartment of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Neurology, University Medical Center Göttingen, Göttingen, GermanyInstitute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Göttingen, GermanyDepartment of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, GermanyDepartment of Neurology, Centre of Neurology and Neurosurgery, Goethe University, Frankfurt, Germany0University Hospital Frankfurt, Frankfurt, GermanyDepartment of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany1Department of Radiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany2Institute for Stroke and Dementia Research, University Hospital Ludwig-Maximilian University, Munich, Germany3Department of Neurology, University Hospital, LMU Munich, Munich, Germany3Department of Neurology, University Hospital, LMU Munich, Munich, Germany4Institute for Neuroradiology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany5Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany6Department of Neurology, University Hospital Bonn, Bonn, Germany5Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany6Department of Neurology, University Hospital Bonn, Bonn, Germany7Department of Neuroradiology, University Hospital, Bonn, Germany8Klinik für Neurologie, Klinikum Altenburger Land, Altenburg, Germany9Klinik für Radiologie, Interventionsradiologie und Neuroradiologie, Klinikum Altenburger Land, Altenburg, Germany0Department of Neurology, School of Medicine Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany0Department of Neurology, School of Medicine Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany1Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany2Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany2Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany3Department of Radiology, Klinikum Osnabrück, Osnabrück, GermanyDepartment of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, GermanyCenter for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany4Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Berlin, Germany, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, GermanyInstitute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany5Institute of Medical Data Science, University Hospital Würzburg, Würzburg, Germany6Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, GermanyDepartment of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, GermanyCenter for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany7Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany8Deutsches Zentrum für Herz-Kreislaufforschung DZHK, Berlin, GermanyBackgroundIn recent years, we have witnessed a continuous, evidence-based expansion of indications for endovascular therapy (EVT) in the treatment of ischaemic stroke, driven by advancements in extended time windows and target vessel occlusion. Our study aimed to evaluate the temporal changes in patients’ characteristics, treatment, and outcomes in clinical practice.MethodsWe used data from the German Stroke Registry, a large national multicentre prospective registry, which includes all patients receiving EVT for ischaemic stroke at its participating centers. We analysed baseline factors, treatment details, and clinical outcomes [Modified Rankin Scale (mRS) at 3 months] over a 5-year period (2017–2021).ResultsWe included 6,251 patients from eight centres. Over time, the characteristics of patients undergoing EVT changed in several aspects (2017 vs. 2021). Patients became older (median age from 76 [IQR: 65–82] to 77 [65–84 years]; ptrend = 0.02), and less severely affected (NIHSS from 15 [11–19] to 13 [8–18]; ptrend <0.001). There was an increase in patients treated more than 6 h after last seen well (22.0% to 28.3%; ptrend<0.001), and more patients were treated for medium vessel occlusion (16.1% to 28.1%; ptrend<0.001). The use of intravenous thrombolysis decreased (52.4% to 40.4%; ptrend<0.01). Good functional outcome declined (percentage of patients with mRS ≤ 2 from 36.0 to 34.9%; aOR 0.94 per year [0.89–0.99]), while mortality at 3 months increased from 25.3% in 2017 to 34.7% in 2021; aOR 1.13 per year [1.07–1.19].ConclusionBetween 2017 and 2021, there were significant shifts in the demographic and clinical profiles of patients undergoing EVT, along with an expansion in EVT indications. Despite these patients presenting with less severe stroke symptoms, improvements in functional outcomes were not observed, and mortality rates increased. These trends may reflect willingness to treat patients with more severe underlying health conditions.https://www.frontiersin.org/articles/10.3389/fneur.2024.1517276/fullischaemic strokeendovascular therapymechanical thrombectomytime trendsreal world data |
| spellingShingle | Christoph Riegler Christoph Riegler Viktoria Rücker Regina von Rennenberg Regina von Rennenberg Kerstin Bollweg Kerstin Bollweg Bastian Cheng Anna C. Alegiani Fabian Flottmann Marlena Schnieder Marielle Ernst Waltraud Pfeilschifter Waltraud Pfeilschifter Waltraud Pfeilschifter Christoffer Kraemer Ruben Mühl-Benninghaus Steffen Tiedt Steffen Tiedt Lars Kellert Hanna Zimmermann Felix J. Bode Felix J. Bode Gabor C. Petzold Gabor C. Petzold Franziska Dorn Jörg Berrouschot Albrecht Bormann Kathleen Bernkopf Silke Wunderlich Tobias Boeckh-Behrens Martina Petersen Lars Udo Krause Stephan Lowens Heinrich J. Audebert Heinrich J. Audebert Eberhard Siebert Peter U. Heuschmann Peter U. Heuschmann Peter U. Heuschmann Christian H. Nolte Christian H. Nolte Christian H. Nolte Christian H. Nolte Time trends in mechanical thrombectomy (2017–2021): do real-world data reflect advances in evidence? Frontiers in Neurology ischaemic stroke endovascular therapy mechanical thrombectomy time trends real world data |
| title | Time trends in mechanical thrombectomy (2017–2021): do real-world data reflect advances in evidence? |
| title_full | Time trends in mechanical thrombectomy (2017–2021): do real-world data reflect advances in evidence? |
| title_fullStr | Time trends in mechanical thrombectomy (2017–2021): do real-world data reflect advances in evidence? |
| title_full_unstemmed | Time trends in mechanical thrombectomy (2017–2021): do real-world data reflect advances in evidence? |
| title_short | Time trends in mechanical thrombectomy (2017–2021): do real-world data reflect advances in evidence? |
| title_sort | time trends in mechanical thrombectomy 2017 2021 do real world data reflect advances in evidence |
| topic | ischaemic stroke endovascular therapy mechanical thrombectomy time trends real world data |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2024.1517276/full |
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