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Procedural factors associated with successful recanalization in patients with acute ischemic stroke treated with endovascular thrombectomy—a nationwide register-based observational study

Wassélius, Johan LU ; Hall, Emma LU orcid ; Ramgren, Birgitta LU ; Andersson, Tommy and Ullberg, Teresa LU (2024) In Interventional Neuroradiology
Abstract

Introduction: Several studies have addressed technical aspects of endovascular thrombectomy (EVT), but it is not well known how procedural factors contribute to technical success in routine healthcare. The aim was to explore factors associated with technically successful EVT on nationwide scale. Methods: We did an observational register-based study assessing factors associated with technical success off anterior circulation EVT in Sweden. The main outcome was successful recanalization defined as modified treatment in cerebral ischemia score 2b-3. The association between baseline and treatment variables and successful recanalization were explored using Chi-square(d) test and univariable logistic regression. Multivariable logistic... (More)

Introduction: Several studies have addressed technical aspects of endovascular thrombectomy (EVT), but it is not well known how procedural factors contribute to technical success in routine healthcare. The aim was to explore factors associated with technically successful EVT on nationwide scale. Methods: We did an observational register-based study assessing factors associated with technical success off anterior circulation EVT in Sweden. The main outcome was successful recanalization defined as modified treatment in cerebral ischemia score 2b-3. The association between baseline and treatment variables and successful recanalization were explored using Chi-square(d) test and univariable logistic regression. Multivariable logistic regression was used to define predictors of successful recanalization. Results: The study included 3211 patients treated during 2015 to 2020. Successful recanalization was achieved in 83.1% (2667) with a gradual improvement in technical outcome over the period. After adjustment for age and occlusion location, thet use of general anesthesia, balloon guide catheter (BGC) and an operator with an overall success rate of >85% were independent predictors of successful recanalization. An overall operator success rate of <80% or 80–85%, and an annual center volume lower than 50 were predicitors of recanalization failure. Conclusion: This study illustrates factors associated with procedural success in endovascular thrombectomy on a nationwide scale including the use of general anesthesia, BGC, annual center volumes >50 cases per year and the overall success rate of the individual operator. It highlights the potential benefit of systematic performance measurements, benchmarking, and continuous training to bring all centers and operators to the highest level of performance.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
acute ischemic stroke treatment, Endovaskular thrombectomy, national quality registry data, success rate, successful recalaization
in
Interventional Neuroradiology
publisher
Centauro srl
external identifiers
  • pmid:38646674
  • scopus:85191043418
ISSN
1591-0199
DOI
10.1177/15910199241248268
language
English
LU publication?
yes
id
d66b3747-c553-49fb-a5c7-c40253553ce7
date added to LUP
2024-05-07 10:28:31
date last changed
2024-05-07 10:35:36
@article{d66b3747-c553-49fb-a5c7-c40253553ce7,
  abstract     = {{<p>Introduction: Several studies have addressed technical aspects of endovascular thrombectomy (EVT), but it is not well known how procedural factors contribute to technical success in routine healthcare. The aim was to explore factors associated with technically successful EVT on nationwide scale. Methods: We did an observational register-based study assessing factors associated with technical success off anterior circulation EVT in Sweden. The main outcome was successful recanalization defined as modified treatment in cerebral ischemia score 2b-3. The association between baseline and treatment variables and successful recanalization were explored using Chi-square(d) test and univariable logistic regression. Multivariable logistic regression was used to define predictors of successful recanalization. Results: The study included 3211 patients treated during 2015 to 2020. Successful recanalization was achieved in 83.1% (2667) with a gradual improvement in technical outcome over the period. After adjustment for age and occlusion location, thet use of general anesthesia, balloon guide catheter (BGC) and an operator with an overall success rate of &gt;85% were independent predictors of successful recanalization. An overall operator success rate of &lt;80% or 80–85%, and an annual center volume lower than 50 were predicitors of recanalization failure. Conclusion: This study illustrates factors associated with procedural success in endovascular thrombectomy on a nationwide scale including the use of general anesthesia, BGC, annual center volumes &gt;50 cases per year and the overall success rate of the individual operator. It highlights the potential benefit of systematic performance measurements, benchmarking, and continuous training to bring all centers and operators to the highest level of performance.</p>}},
  author       = {{Wassélius, Johan and Hall, Emma and Ramgren, Birgitta and Andersson, Tommy and Ullberg, Teresa}},
  issn         = {{1591-0199}},
  keywords     = {{acute ischemic stroke treatment; Endovaskular thrombectomy; national quality registry data; success rate; successful recalaization}},
  language     = {{eng}},
  publisher    = {{Centauro srl}},
  series       = {{Interventional Neuroradiology}},
  title        = {{Procedural factors associated with successful recanalization in patients with acute ischemic stroke treated with endovascular thrombectomy—a nationwide register-based observational study}},
  url          = {{http://dx.doi.org/10.1177/15910199241248268}},
  doi          = {{10.1177/15910199241248268}},
  year         = {{2024}},
}