现代机械血栓切除术时代急性脑卒中血管内治疗的时间趋势：JR-NET4 研究。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-11-03 DOI:10.1016/j.jstrokecerebrovasdis.2024.108110

Mikito Hayakawa MD, PhD , Hiroshi Yamagami MD, PhD , Yuji Matsumarum MD, PhD , Koji Hirata MD, PhD , Hisayuki Hosoo MD, PhD , Yoshiro Ito MD, PhD , Aiki Marushima MD, PhD , Wataro Tsuruta MD, PhD , Koji Iihara MD, PhD , Akira Ishii MD, PhD , Hirotoshi Imamura MD, PhD , Chiaki Sakai MD, PhD , Tetsu Satow MD, PhD , Shinichi Yoshimura MD, PhD , Nobuyuki Sakai MD, DMSc , the JR-NET4 Study Group

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引用次数: 0

摘要

目的：本研究旨在探讨 2015 年五项关键性试验将急性中风血管内血栓切除术（EVT）确立为 "标准治疗 "后的全国趋势：本研究旨在探讨继2015年五项关键性试验将急性卒中血管内血栓切除术（EVT）确立为 "标准治疗 "后，全国范围内EVT的发展趋势：日本神经血管内治疗登记4是一项全国性的回顾性研究，登记了2015年1月至2019年12月期间在166个中心由日本神经血管内治疗学会认证的专家进行神经介入治疗的连续患者。我们提取了接受EVT的患者，并分析了基线特征、血管重建程序和结果的年度趋势：共纳入 13090 名患者（75.3±12.2 岁，5637 名女性）。分析表明，患者年龄和发病后 6 小时以上的治疗次数逐年增加。然而，病前独立的患者和大血管闭塞的患者每年都在减少。在整个研究期间，支架抽吸技术的使用频率和再灌注成功率分别从 19.9% 和 81.4% 显著增至 51.0% 和 83.9%。获得良好治疗效果（30 天后改良兰金量表评分为 0-2 分）或死亡或出现颅内出血并发症的患者人数趋势保持不变。然而，在调整临床和治疗特征后，日历时间与良好结果相关（几率比为1.040；P = 0.015）：结论：在研究期间，EVT适应症扩大到了具有较差预后相关特征的患者。然而，由于技术进步等因素，再灌注状况得到了适度但显著的改善，从而维持了EVT后的临床结果：URL: https://www.umin.ac.jp/ctr/; Unique identifier：UMIN000038869。

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Temporal trends in endovascular therapy for acute stroke in the era of modern mechanical thrombectomy: The JR-NET4 study

Objectives

This study aimed to examine nationwide trends in acute stroke endovascular thrombectomy (EVT) following five pivotal trials in 2015 that established it as the ‘standard of care’.

Methods

The Japanese Registry of NeuroEndovascular Therapy 4 was a nationwide retrospective study registering consecutive patients who underwent neurointervention by specialists certified by the Japanese Society for Neuroendovascular Therapy at 166 centers from January 2015 to December 2019. We extracted patients who underwent EVT, and analyzed the annual trends in baseline characteristics, revascularization procedures and outcomes.

Results

A total of 13,090 patients (75.3 ± 12.2 years, 5637 women) were included. Analyses revealed an annual increase in patient age and treatments beyond 6 h after onset. However, there was an annual decline in premorbidly independent patients and those with large vessel occlusion. The frequency of stent-aspiration techniques and rate of successful reperfusions significantly increased from 19.9 % to 51.0 % and from 81.4 % to 83.9 %, respectively through the study period. Trends in patients achieving a favorable (modified Rankin Scale score of 0-2 at 30 days) or fatal outcome, or experiencing intracranial hemorrhagic complications remained unchanged. However, calendar time was associated with favorable outcomes after adjusting for clinical and treatment characteristics (odds ratio, 1.040; P = 0.015).

Conclusions

During the study period, EVT indications expanded for patients with characteristics linked to worse outcomes. However, factors such as advancements in techniques, have led to modest but significant improvements in reperfusion status, leading to maintenance of the post-EVT clinical outcomes.

Registration

URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000038869

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.