Trends in the effectiveness of endovascular recanalization for acute stroke: is a change taking place?
BACKGROUND
Despite recent technical advances in endovascular recanalization, there is skepticism regarding its clinical effectiveness compared with intravenous thrombolysis for treating acute ischemic stroke. We aimed to delineate its effectiveness and safety and their change over time.


METHODS
Using a prospective, multicenter stroke registry database, we identified 872 patients with ischemic stroke who underwent recanalization therapy with intravenous thrombolysis alone (IVT; n = 533) or endovascular recanalization with or without intravenous thrombolysis (EVT; n = 339) between April 2008 and January 2012. All subjects had National Institute of Health Stroke Scale score of 10 or more and arrived at the hospital within 4.5 hours of onset. Propensity score was used to address baseline imbalances between treatment groups, but balance adjustment was not performed for subgroup analyses.


RESULTS
The primary outcome was modified Rankin Scale score of 0-2 at discharge. The year-by-year effectiveness and safety of EVT and IVT were compared. Before 2010, the primary outcome was not associated with the recanalization method. However, in 2011, EVT increased the odds of having a primary outcome compared with IVT (adjusted odds ratio [OR], 1.87; 95% confidence interval [CI], 1.08-3.23). In 2011, EVT was superior to IVT regarding the achievement of a favorable outcome at 3 months after stroke (OR, 1.99; 95% CI, 1.10-3.59). The odds of in-hospital mortality and 3-month mortality were not different over 4 years.


CONCLUSIONS
There might have been a change in the effectiveness of endovascular recanalization compared with intravenous thrombolysis, but the results remain tentative until prospectively evaluated.
Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Beom Joon
BJ
Kim
Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Moon-Ku
MK
Han
Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea.
Tai Hwan
TH
Park
Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea.
Sang-Soon
SS
Park
Department of Neurology, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea.
Kyung Bok
KB
Lee
Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea.
Byung-Chul
BC
Lee
Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea.
Kyung-Ho
KH
Yu
Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea.
Mi Sun
MS
Oh
Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea.
Jae Kwan
JK
Cha
Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea.
Dae-Hyun
DH
Kim
Department of Neurology, Yeungnam University Medical Center, Daegu, Republic of Korea.
Jun
J
Lee
Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea.
Soo Joo
SJ
Lee
Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea.
Youngchai
Y
Ko
Department of Neurology, Eulji General Hospital, Seoul, Republic of Korea.
Jong-Moo
JM
Park
Department of Neurology, Eulji General Hospital, Seoul, Republic of Korea.
Kyusik
K
Kang
Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
Yong-Jin
YJ
Cho
Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
Keun-Sik
KS
Hong
Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea.
Joon-Tae
JT
Kim
Department of Neurology, Jeju National University Hospital, Jeju, Republic of Korea.
Jay Chol
JC
Choi
Department of Neurology, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
Dong-Eog
DE
Kim
Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
Juneyoung
J
Lee
Biostatistical Consulting Unit, Soonchunhyang University Medical Center, Seoul, Republic of Korea.
Ji Sung
JS
Lee
Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine & Saint Mary's Health Care at Mercy Health, Grand Rapids, Michigan.
Philip B
PB
Gorelick
Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
Byung-Woo
BW
Yoon
Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. Electronic address: braindoc@snu.ac.kr.
Hee-Joon
HJ
Bae
D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000706:statistics & numerical data; D057510:Endovascular Procedures / Q000379:methods* / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D056910:Republic of Korea; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
Acute ischemic stroke; comparative effectiveness research; endovascular recanalization; propensity score; thrombolysis