Clinical effectiveness of endovascular stroke treatment in the early and extended time windows

You obviously have the wrong definition of efficacy and effectiveness. 100% recovery  is the only goal in stroke and you're not even measuring that.

Clinical effectiveness of endovascular stroke treatment in the early and extended time windows

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Raul G Nogueira, Diogo C Haussen, David S Liebeskind, ...

First Published April 20, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/17474930211005740

Article information

 

Abstract

Background

The clinical efficacy of mechanical thrombectomy has been unequivocally demonstrated in multiple randomized clinical trials. However, these studies were performed in carefully selected centers and utilized strict inclusion criteria.

Aim

We aimed to assess the clinical effectiveness of mechanical thrombectomy in a prospective registry.

Methods

A total of 2008 patients from 76 sites across 12 countries were enrolled in a prospective open-label mechanical thrombectomy registry. Patients were categorized into the corresponding cohorts of the SWIFT-Prime, DAWN, and DEFUSE 3 trials according to the basic demographic and clinical criteria without considering specific parenchymal imaging findings. Baseline and outcome variables were compared across the corresponding groups.

Results

As compared to the treated patients in the actual trials, registry-derived patients tended to be younger and had lower baseline ASPECTS. In addition, time to treatment was earlier and the use of intravenous tissue plasminogen activator (IV-tPA) and general anesthesia were higher in DAWN- and DEFUSE-3 registry derived patients versus their corresponding trials. Reperfusion rates were higher in the registry patients. The rates of 90-day good outcome (mRS0-2) in registry-derived patients were comparable to those of the patients treated in the corresponding randomized clinical trials (SWIFT-Prime, 64.5% vs. 60.2%; DAWN, 50.4% vs. 48.6%; Beyond-DAWN: 52.4% vs. 48.6%; DEFUSE 3, 52% vs. 44.6%, respectively; all P > 0.05). Registry-derived patients had significant less disability(So you think your tyranny of low expectation is OK for your patients? Talk to them sometimes.) than the corresponding randomized clinical trial controls (ordinal modified Rankin Scale (mRS) shift odds ratio (OR), P < 0.05 for all).

Conclusion

Our study provides favorable generalizability data for the safety and efficacy of thrombectomy in the “real-world” setting and supports that patients may be safely treated outside the constraints of randomized clinical trials.

Keywords Stroke, thrombectomy, registry

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