EXPRESS: Clinical Effectiveness of Endovascular Stroke Treatment in the Early and Extended Time Windows. International journal of stroke : official journal of the International Stroke Society Nogueira, R., Haussen, D. C., Liebeskind, D. S., Jovin, T. G., Gupta, R., Saver, J., Jadhav, A., Budzik, R., Baxter, B., Krajina, A., BonafA, A., Malek, A. R., Narata, A. P., Mohammaden, M. H., Zhang, Y., Morgan, P., Ji, M., Bartolini, B., English, J., Albers, G. W., Mlynash, M., Lansberg, M. G., Frankel, M. R., Pereira, V., Veznedaroglu, E. 2021: 17474930211005740


BackgroundThe clinical efficacy of mechanical thrombectomy (MT) has been unequivocally demonstrated in multiple randomized clinical trials (RCTs). However, these studies were performed in carefully selected centers and utilized strict inclusion criteria. AimWe aimed to assess the clinical effectiveness of MT in a prospective registry.MethodsA total of 2008 patients from 76 sites across 12 countries were enrolled in a prospective open-label MT 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. ResultsAs 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 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 RCTs (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 than the corresponding RCT controls (ordinal mRS shift OR, P<0.05 for all).ConclusionOur study provides favorable generalizability data for the safety and efficacy of thrombectomy in the areal-worlda setting and supports that patients may be safely treated outside the constraints of RCTs.

View details for DOI 10.1177/17474930211005740

View details for PubMedID 33705210