Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, September 6, 2018

Impact of the Thrombectomy Trials on the Management and Outcome of Large Vessel Stroke: Data From the Lyon Stroke Center

Lots of statistics to make sure laypersons can't use this and ask intelligent question of their doctors.  Again with the cherry picking of patients. NO stroke survivor should be left behind.

Impact of the Thrombectomy Trials on the Management and Outcome of Large Vessel Stroke: Data From the Lyon Stroke Center 


Louis Viannay1, Julie Haesebaert2, Fannie Florin3, Roberto Riva1, Laura Mechtouff3, Benjamin Gory1, Elodie Ong3, Paul-Emile Labeyrie1, Laurent Derex2,3, Marc Hermier1, Leila Chamard1, Lise-Prune Berner1, Roxana Ameli1, Yves Berthezène1,4, Francis Turjman1, Norbert Nighoghossian3,4 and Tae-Hee Cho3,4*
  • 1Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
  • 2Health Information Department, HESPER EA7425, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
  • 3Department of Stroke Medicine, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
  • 4CREATIS, CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
Introduction: Randomized trials (RT) have recently validated the superiority of thrombectomy over standard medical care, including intravenous thrombolysis (IVT). However, data on their impact on routine clinical care remains scarce.
Methods: Using a prospective observational registry, we assessed: (1) the clinical and radiological characteristics of all consecutive patients treated with thrombectomy; (2) the outcome of all patients with M1 occlusion (treated with thrombectomy or IVT alone). Two periods were compared: before (2013–2014) and after (2015–2016) the publication of RT.
Results: Endovascular procedures significantly increased between the two periods (N = 82 vs. 314, p < 0.0001). In 2015–2016, patients were older (median [IQR]: 69 [57-80]; vs. 66 [53-74]; p = 0.008), had shorter door-to-clot times (69 [47-95]; vs. 110 [83-155]; p < 0.0001) resulting in a trend toward shorter delay from symptom onset to reperfusion (232 [185-300]; vs. 250 [200-339]; p = 0.1), with higher rates of reperfusion (71 vs. 48%; p = 0.0001). Conversely, no significant differences in baseline NIHSS scores, ASPECTS, delay to IVT or intracranial hemorrhage were found. In 2015–2016, patients with M1 occlusion were treated with thrombectomy more often than in 2013–2014 (87 vs. 32%, respectively; p < 0.0001), with a significant improvement in clinical outcome (shift analysis, lower modified Rankin scale scores: OR = 1.68; 95% CI: 1.10–2.57; p = 0.017).
Conclusion: Following the publication of RT, thrombectomy was rapidly implemented with significant improvements in intrahospital delay and reperfusion rates. Treatment with thrombectomy increased with better clinical outcomes in patients with M1 occlusion.

Introduction

In 2013, the future of endovascular therapy (EVT) in acute ischemic stroke was uncertain, as three consecutive randomized trials failed to demonstrate the superiority of thrombectomy combined with intravenous thrombolysis (IVT) over IVT alone (13). Subsequent trials have since established the effectiveness of EVT for patients with large vessel occlusions who were suitably selected by cerebral and arterial imaging (411).
Preliminary reports from monocentric (12, 13) or multicentric (14, 15) studies indicate that EVT seems applicable in the “real” world of clinical practice, with similar results to those of controlled trials. Still, little data is available on how systems of care have started to adapt to this paradigm shift in acute stroke therapy. A single study recently reported on the increasing EVT case volumes across the Unites States since the publication of the positive trials (16). The extent to which EVT use has evolved after the pivotal trials and its impact on local practices need to be considered to plan further quality improvement efforts, both within comprehensive stroke centers (CSC, i.e., EVT-capable hospitals) and beyond.
Our institution is the only CSC serving the greater Lyon metropolitan area (population: 2.3 million), treating ~1,600 ischemic stroke patients each year (Figure 1). Prior to the publication of the first positive trial (4), EVT was not considered as standard care, and thus was not systematically considered for patients with proximal intracranial occlusions. Thereafter, local processes were modified to implement thrombectomy in all eligible patients referred to our CSC. Our objective was to assess the effects of this major shift in our reperfusion strategy by comparing two periods: before (January 1st 2013–December 31st 2014) and after (January 1st 2015–December 31st 2016) the publication of the first positive EVT trial. Specifically, we first compared the typology of all consecutive EVT cases (e.g., number of procedures, baseline clinical and radiological characteristics) to assess the development of EVT within our institution. Secondly, we compared the outcome of all patients with M1 occlusion who underwent a revascularization procedure (IVT and/or EVT).

No comments:

Post a Comment