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Temporal Changes in Care Processes and Outcomes for Endovascular Treatment of Acute Ischemic Stroke: Retrospective Registry Data from Three Korean Centers

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Author(s)
Jin Soo LeeSeong-Joon LeeJi Man HongJin Wook ChoiJeong-Ho HongHyuk-Won ChangChang-Hyun KimYong-Won KimDong-Hun KangYong-Sun KimBruce OvbiageleAndrew M. DemchukYang-Ha HwangSung-Il Sohn
Keimyung Author(s)
Sohn, Sung IlKim, Chang HyunHong, Jeong HoChang, Hyuk Won
Department
Dept. of Neurology (신경과학)
Dept. of Neurosurgery (신경외과학)
Dept. of Radiology (영상의학)
Journal Title
Neurointervention
Issued Date
2018
Volume
13
Issue
1
Keyword
Cerebral hemorrhageCerebral infarctionLearning curveReperfusionThrombectomyTreatment outcome
Abstract
BACKGROUND AND PURPOSE:
The purpose of the current study is to evaluate the influence of temporal patterns related to the availability of new endovascular treatment (EVT) devices on care processes and outcomes among patients with AIS.

MATERIALS AND METHODS:
We enrolled 720 consecutive patients (January 2011 to May 2016) in a retrospective registry, ASIAN KR, from three Korean hospitals, who received EVT for acute ischemic stroke (AIS) caused by cervicocephalic arterial occlusions. We performed period-to-period analyses based on stent retriever reimbursement and the availability of second-generation direct-aspiration devices (Period 1: January 2011-July 2014 vs. Period 2: August 2014-May 2016); time metrics and outcomes were compared when the onset-to-puncture time was <720 min among patients with EVT for intracranial occlusion.

RESULTS:
Period 2 had better post-EVT outcomes (3-month modified Rankin Scale 0-2 or equal to prestroke score, 48.3% vs. 60.2%, P=0.004), more successful reperfusion rates (modified Treatment In Cerebral Ischemia 2b-3, 74.2% vs. 82.2%, P=0.019), fewer subarachnoid hemorrhages (modified Fisher grade 3-4, 5.5% vs. 2.0%, P=0.034) and lower hemorrhagic transformation rates (any intracerebral hemorrhage, 35.3 vs. 22.7%, P=0.001) than Period 1. Compared to Period 1, Period 2 had a shorter door-to-puncture time (median 109 vs. 90 min, P<0.001), but longer onset-to-door time (129 vs. 143 min, P=0.057).

CONCLUSION:
Recent temporal improvements in post-EVT AIS outcomes in Korea are likely due to a combination of enhanced hospital care processes and administration of newer thrombectomy devices.
Keimyung Author(s)(Kor)
손성일
김창현
홍정호
장혁원
Publisher
School of Medicine (의과대학)
Citation
Jin Soo Lee et al. (2018). Temporal Changes in Care Processes and Outcomes for Endovascular Treatment of Acute Ischemic Stroke: Retrospective Registry Data from Three Korean Centers. Neurointervention, 13(1), 2–12. doi: 10.5469/neuroint.2018.13.1.2
Type
Article
ISSN
2093-9043
DOI
10.5469/neuroint.2018.13.1.2
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41499
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
1. School of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학)
1. School of Medicine (의과대학) > Dept. of Radiology (영상의학)
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