Temporal Changes in Care Processes and Outcomes for Endovascular Treatment of Acute Ischemic Stroke: Retrospective Registry Data from Three Korean Centers
이진수, 이성준, 홍지만, 최진욱, 홍정호, 장혁원, 김창현, 김용원, 강동훈, 김용선, Ovbiagele Bruce, Demchuk Andrew M., 황양하, 손성일,
소속 상세정보
이진수 ( Lee Jin-Soo )
Ajou University School of Medicine Department of Neurology
이성준 ( Lee Seong-Joon )
Ajou University School of Medicine Department of Neurology
홍지만 ( Hong Ji-Man )
Ajou University School of Medicine Department of Neurology
최진욱 ( Choi Jin-Wook )
Ajou University School of Medicine Department of Radiology
홍정호 ( Hong Jeong-Ho )
Keimyung University Dongsan Medical Center Department of Neurology
장혁원 ( Chang Hyuk-Won )
Keimyung University Dongsan Medical Center Department of Radiology
김창현 ( Kim Chang-Hyun )
Keimyung University Dongsan Medical Center Department of Neurosurgery
김용원 ( Kim Yong-Won )
Kyungpook National University School of Medicine Department of Neurology
강동훈 ( Kang Dong-Hun )
Kyungpook National University School of Medicine Department of Radiology
김용선 ( Kim Yong-Sun )
Kyungpook National University School of Medicine Department of Radiology
( Ovbiagele Bruce )
Medical University of South Carolina Department of Neurology
( Demchuk Andrew M. )
University of Calgary Hotchkiss Brain Institute Departments of Clinical Neurosciences and Radiology
황양하 ( Hwang Yang-Ha )
Kyungpook National University School of Medicine Department of Neurology
손성일 ( Sohn Sung-Il )
Keimyung University Dongsan Medical Center Department of Neurology
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.
키워드
Cerebral infarction; Thrombectomy; Reperfusion; Cerebral hemorrhage; Learning curve; Treatment outcome
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