Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (May 2018)
Endovascular Therapy in Ischemic Stroke With Acute Large‐Vessel Occlusion: Recovery by Endovascular Salvage for Cerebral Ultra‐Acute Embolism Japan Registry 2
- Shinichi Yoshimura,
- Nobuyuki Sakai,
- Kazutaka Uchida,
- Hiroshi Yamagami,
- Masayuki Ezura,
- Yasushi Okada,
- Kazuo Kitagawa,
- Kazumi Kimura,
- Makoto Sasaki,
- Norio Tanahashi,
- Kazunori Toyoda,
- Eisuke Furui,
- Yuji Matsumaru,
- Kazuo Minematsu,
- Takeshi Morimoto,
- Naoya Kuwayama,
- Kuniaki Ogasawara,
- Koji Iihara,
- Masataka Takeuchi,
- Masafumi Morimoto,
- Toshiyuki Onda,
- Masunari Shibata,
- Takahiro Ohta,
- Keisuke Imai,
- Ryo Itabashi,
- Taro Yamashita,
- Norihito Fukawa,
- Naoto Kimura,
- Ryosuke Doijiri,
- Hajime Ohta,
- Yukiko Enomoto,
- Chisaku Kanbayashi,
- Ikuya Yamaura,
- Hideyuki Ishihara,
- Yuki Kamiya,
- Makoto Hayase,
- Kouhei Nii,
- Junya Kobayashi,
- Hiroaki Yasuda,
- Ryushi Kondo,
- Daisuke Yamamoto,
- Manabu Sakaguchi,
- Junichiro Satomi,
- Yoshiki Yagita,
- Akira Handa,
- Atsushi Shindo,
- Nagayasu Hiyama,
- Naoki Toma,
- Tomoyuki Tsumoto,
- Wataro Tsuruta,
- Keigo Matsumoto,
- Yoshihiro Kiura,
- Takaaki Yamazaki,
- Taketo Hatano,
- Yoshihisa Matsumoto,
- Takao Kojima,
- Norio Ikeda,
- Shigeyuki Sakamoto,
- Hiroyuki Ohnishi,
- Koichi Haraguchi,
- Naoyuki Uchiyama
Affiliations
- Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
- Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
- Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
- Hiroshi Yamagami
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
- Masayuki Ezura
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
- Yasushi Okada
- Cerebrovascular Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
- Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
- Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Makoto Sasaki
- Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan
- Norio Tanahashi
- Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan
- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Eisuke Furui
- Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
- Yuji Matsumaru
- Department of Neurosurgery, Tsukuba University, Tsukuba, Japan
- Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Naoya Kuwayama
- Kuniaki Ogasawara
- Koji Iihara
- Masataka Takeuchi
- Masafumi Morimoto
- Toshiyuki Onda
- Masunari Shibata
- Takahiro Ohta
- Keisuke Imai
- Ryo Itabashi
- Taro Yamashita
- Norihito Fukawa
- Naoto Kimura
- Ryosuke Doijiri
- Hajime Ohta
- Yukiko Enomoto
- Chisaku Kanbayashi
- Ikuya Yamaura
- Hideyuki Ishihara
- Yuki Kamiya
- Makoto Hayase
- Kouhei Nii
- Junya Kobayashi
- Hiroaki Yasuda
- Ryushi Kondo
- Daisuke Yamamoto
- Manabu Sakaguchi
- Junichiro Satomi
- Yoshiki Yagita
- Akira Handa
- Atsushi Shindo
- Nagayasu Hiyama
- Naoki Toma
- Tomoyuki Tsumoto
- Wataro Tsuruta
- Keigo Matsumoto
- Yoshihiro Kiura
- Takaaki Yamazaki
- Taketo Hatano
- Yoshihisa Matsumoto
- Takao Kojima
- Norio Ikeda
- Shigeyuki Sakamoto
- Hiroyuki Ohnishi
- Koichi Haraguchi
- Naoyuki Uchiyama
- DOI
- https://doi.org/10.1161/JAHA.118.008796
- Journal volume & issue
-
Vol. 7,
no. 9
Abstract
BackgroundEndovascular therapy has been shown to be effective in patients with acute cerebral large‐vessel occlusion, but real‐world efficacies are unknown. Methods and ResultsWe conducted a prospective registry at 46 centers between October 2014 and January 2017. Eligible patients were those who were aged 20 years or older, with acute cerebral large‐vessel occlusion, and who were hospitalized within 24 hours of the onset. We enrolled both consecutive patients who were treated with or without endovascular therapy. Endovascular therapy included thrombectomy, balloon angioplasty, stenting, local fibrinolysis, and piercing. The primary outcome was a favorable outcome as defined by a modified Rankin Scale of 0 to 2 at 90 days after onset. Secondary outcomes were modified Rankin Scale of 0 to 1 and mortality. Safety outcomes were intracerebral hemorrhage or a recurrence of ischemic stroke. We constructed the 2242 (1121 each) propensity score–matched patients cohort based on a propensity score for endovascular therapy and estimated the adjusted odds ratio, followed by sensitivity analyses on original 2399 (1278 in endovascular therapy versus 1121 in no endovascular therapy) patients. In the propensity score–matched cohort, favorable outcomes were observed in 35.3% and 30.7% of patients in the endovascular therapy and no endovascular therapy groups, respectively (P=0.02). The adjusted odds ratio for the favorable outcome was 1.44 (95% confidence interval, 1.10–1.86, P=0.007). The efficacy of endovascular therapy in achieving favorable outcomes did not differ between our subgroups and in the sensitivity analyses. ConclusionsEndovascular therapy decreased disabilities at 90 days in real‐world patients with acute cerebral large‐vessel occlusion. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT02419794.
Keywords
