Frontiers in Neurology (Feb 2025)
Time trends in mechanical thrombectomy (2017–2021): do real-world data reflect advances in evidence?
- 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
Affiliations
- Christoph Riegler
- Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Christoph Riegler
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany
- Regina von Rennenberg
- Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Regina von Rennenberg
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Kerstin Bollweg
- Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Kerstin Bollweg
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Anna C. Alegiani
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Fabian Flottmann
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Marlena Schnieder
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Marielle Ernst
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Göttingen, Germany
- Waltraud Pfeilschifter
- Department of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany
- Waltraud Pfeilschifter
- Department of Neurology, Centre of Neurology and Neurosurgery, Goethe University, Frankfurt, Germany
- Waltraud Pfeilschifter
- 0University Hospital Frankfurt, Frankfurt, Germany
- Christoffer Kraemer
- Department of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany
- Ruben Mühl-Benninghaus
- 1Department of Radiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany
- Steffen Tiedt
- 2Institute for Stroke and Dementia Research, University Hospital Ludwig-Maximilian University, Munich, Germany
- Steffen Tiedt
- 3Department of Neurology, University Hospital, LMU Munich, Munich, Germany
- Lars Kellert
- 3Department of Neurology, University Hospital, LMU Munich, Munich, Germany
- Hanna Zimmermann
- 4Institute for Neuroradiology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- Felix J. Bode
- 5Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany
- Felix J. Bode
- 6Department of Neurology, University Hospital Bonn, Bonn, Germany
- Gabor C. Petzold
- 5Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany
- Gabor C. Petzold
- 6Department of Neurology, University Hospital Bonn, Bonn, Germany
- Franziska Dorn
- 7Department of Neuroradiology, University Hospital, Bonn, Germany
- Jörg Berrouschot
- 8Klinik für Neurologie, Klinikum Altenburger Land, Altenburg, Germany
- Albrecht Bormann
- 9Klinik für Radiologie, Interventionsradiologie und Neuroradiologie, Klinikum Altenburger Land, Altenburg, Germany
- Kathleen Bernkopf
- 0Department of Neurology, School of Medicine Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Silke Wunderlich
- 0Department of Neurology, School of Medicine Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Tobias Boeckh-Behrens
- 1Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
- Martina Petersen
- 2Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany
- Lars Udo Krause
- 2Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany
- Stephan Lowens
- 3Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany
- Heinrich J. Audebert
- Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Heinrich J. Audebert
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Eberhard Siebert
- 4Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Berlin, Germany, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany
- Peter U. Heuschmann
- 5Institute of Medical Data Science, University Hospital Würzburg, Würzburg, Germany
- Peter U. Heuschmann
- 6Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
- Christian H. Nolte
- Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Christian H. Nolte
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Christian H. Nolte
- 7Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Christian H. Nolte
- 8Deutsches Zentrum für Herz-Kreislaufforschung DZHK, Berlin, Germany
- DOI
- https://doi.org/10.3389/fneur.2024.1517276
- Journal volume & issue
-
Vol. 15
Abstract
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.
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