Abstract
Background and Purpose—
Although
several clinical studies suggested the beneficial effects of edaravone
in acute ischemic stroke, most were performed under settings that differ
from those in the current treatment strategy, which has dramatically
changed with progress in reperfusion therapies. This study aimed to
evaluate the efficacy of edaravone in patients with acute ischemic
stroke treated by emergent endovascular reperfusion therapy.
Methods—
We
conducted a retrospective observational study using a national
administrative database. Patients with acute ischemic stroke treated by
emergent endovascular reperfusion therapy were identified and
dichotomized by whether edaravone was used within 2 days of admission.
We compared the functional independence at hospital discharge,
in-hospital mortality, and intracranial hemorrhage after admission
between groups, adjusted by a well-validated case-mix adjustment model,
in multivariate mixed-effect regression and propensity score matching
analyses.
Results—
Of
11 508 patients eligible for analysis, 10 281 (89.3%) received
edaravone therapy. The established risk adjustment model had good
predictability for functional independence at hospital discharge, with
an area under the receiver operating characteristic curve of 0.74. In
the mixed-effect regression analysis, edaravone use was significantly
associated with greater functional independence at hospital discharge
(32.3% in the edaravone group versus 25.9% in the control group;
adjusted odds ratio, 1.21; 95% confidence interval, 1.03–1.41), lower
in-hospital mortality (9.9% in the edaravone group versus 17.4% in the
control group; adjusted odds ratio, 0.52; 95% confidence interval,
0.43–0.62), and reduced intracranial hemorrhage after admission (1.4% in
the edaravone group versus 2.7% in the control group; adjusted odds
ratio, 0.55; 95% confidence interval, 0.37–0.82). Results of the
propensity score matching analysis corroborated these results.
Conclusions—
This
retrospective analysis of a Japanese nationwide administrative database
suggested that combination therapy with edaravone and endovascular
reperfusion therapy could be a promising therapeutic strategy in acute
ischemic stroke. Further randomized control trials are warranted.
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