Eligibility and Predictors for Acute Revascularization Procedures in a Stroke Center.

Details

Serval ID
serval:BIB_6CA78689B16E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Eligibility and Predictors for Acute Revascularization Procedures in a Stroke Center.
Journal
Stroke
Author(s)
Vanacker P., Lambrou D., Eskandari A., Mosimann P.J., Maghraoui A., Michel P.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
07/2016
Peer-reviewed
Oui
Volume
47
Number
7
Pages
1844-1849
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Endovascular treatment (EVT) is a new standard of care for selected, large vessel occlusive strokes. We aimed to determine frequency of potentially eligible patients for intravenous thrombolysis (IVT) and EVT in comprehensive stroke centers. In addition, predictors of EVT eligibility were derived.
Patients from a stroke center-based registry (2003-2014), admitted within 24 hours of last proof of usual health, were selected if they had all data to determine IVT and EVT eligibility according to American Heart Association/American Stroke Association (AHA/ASA) guidelines (class I-IIa recommendations). Moreover, less restrictive criteria adapted from randomized controlled trials and clinical practice were tested. Maximum onset-to-door time windows for IVT eligibility were 3.5 hours (allowing door-to-needle delay of ≤60 minutes) and 4.5 hours for EVT eligibility (door-to-groin delay ≤90 minutes). Demographic and clinical information were used in logistic regression analysis to derive variables associated with EVT eligibility.
A total of 2704 patients with acute ischemic stroke were included, of which 26.8% were transfers. Of all patients with stroke arriving at our comprehensive stroke center, a total proportion of 12.4% patients was eligible for IVT. Frequency of EVT eligibility differed between AHA/ASA guidelines and less restrictive approach: 2.9% versus 4.9%, respectively, of all patients with acute ischemic stroke and 10.5% versus 17.7%, respectively, of all patients arriving within <6 hours. Predictors for AHA-EVT eligibility were younger, shorter onset-to-admission delays, higher National Institutes of Health Stroke Scale (NIHSS), decreased vigilance, hemineglect, absent cerebellar signs, atrial fibrillation, smoking, and decreasing glucose levels (area under the curve=0.86).
Of patients arriving within 6 hours at a comprehensive stroke center, 10.5% are EVT eligible according to AHA/ASA criteria, 17.7% according to criteria resembling randomized controlled trials, and twice as many patients are IVT eligible (36.2%).

Keywords
Administration, Intravenous, Aged, Brain Ischemia/drug therapy, Brain Ischemia/surgery, Eligibility Determination, Endovascular Procedures, Female, Hospitals, Special, Humans, Male, Patient Selection, Patient Transfer, Practice Guidelines as Topic, Referral and Consultation, Registries, Thrombectomy/methods, Thrombolytic Therapy, Tissue Plasminogen Activator/therapeutic use, Treatment Outcome
Pubmed
Open Access
Yes
Create date
18/06/2016 15:30
Last modification date
20/08/2019 14:26
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