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How many stroke patients might be eligible for mechanical thrombectomy?
Salwa El Tawil1, Bharath Cheripelli1, Xuya Huang1
1Institute of Neuroscience and Psychology, University of Glasgow, UK.
European Stroke Journal
|April 23, 2019
Summary
Endovascular treatment for acute stroke shows promise, but trial eligibility varies greatly. Only 1% of patients met criteria for all studies, highlighting the need for standardized acute stroke treatment protocols.
Area of Science:
- Neurology
- Interventional Radiology
- Clinical Trials
Background:
- Endovascular treatment (EVT) improves outcomes in acute stroke compared to medical management alone.
- Seven major clinical trials have reported EVT outcomes.
- These trials utilized diverse clinical and imaging selection criteria.
Purpose of the Study:
- To compare patient eligibility across different acute stroke intervention trial protocols.
- To estimate the proportion of acute stroke patients eligible for endovascular treatment under various trial criteria.
Main Methods:
- Retrospective analysis of 263 patients from a single center database.
- Data included computed tomography angiography (CTA) and computed tomography perfusion (CTP) within 6 hours of stroke onset.
- Applied inclusion/exclusion criteria from seven key EVT trials (MR CLEAN, EXTEND-IA, ESCAPE, SWIFT-PRIME, REVASCAT, THERAPY, THRACE).
Main Results:
- Individual trial eligibility ranged from 3% to 53%.
- Only 1% of patients met criteria for all seven trials.
- Absence of large artery occlusion on CTA was the most common exclusion; perfusion and NIHSS criteria also excluded many patients.
Conclusions:
- Approximately 15% of acute stroke patients presenting within 6 hours are potentially eligible for EVT.
- Significant heterogeneity exists in clinical trial eligibility criteria for endovascular stroke treatment.
- Limited overlap in criteria across trials restricts patient access to EVT.
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