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Reasons for Not Performing Mechanical Thrombectomy: A Population-Based Study of Stroke Codes
Daniel Guisado-Alonso1, Alejandro Martínez-Domeño1, Luis Prats-Sánchez1
1Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.).
Stroke
|July 22, 2021
Summary
Mechanical thrombectomy (MT) is effective for acute ischemic stroke (AIS). This study found that 18.4% of AIS patients received MT, but potentially modifiable reasons excluded many, suggesting room for expanded treatment eligibility.
Area of Science:
- Neurology
- Interventional Neurology
- Public Health
Background:
- Mechanical thrombectomy (MT) is a proven treatment for acute ischemic stroke (AIS) caused by large intracranial vessel occlusion.
- However, a significant proportion of eligible AIS patients do not receive MT.
- Understanding exclusion criteria is crucial for optimizing treatment access.
Purpose of the Study:
- To identify and analyze the reasons for excluding patients with AIS from MT.
- To estimate the potential increase in MT eligibility by addressing modifiable exclusion factors.
Main Methods:
- Analysis of a prospective, population-based, multicenter registry (Codi Ictus Catalunya) of all stroke code activations from January to June 2018.
- Evaluation of 2203 AIS patients, categorizing reasons for MT exclusion into modifiable and non-modifiable.
Main Results:
- Only 18.4% (405/2203) of AIS patients underwent MT.
- The primary non-modifiable reason for exclusion was the absence of large intracranial vessel occlusion (41.9%).
- Potentially modifiable reasons included mild clinical presentation (10.1%), neuroimaging criteria (5.9%), and age/comorbidities (5.9%).
Conclusions:
- Addressing modifiable exclusion criteria could increase MT eligibility for AIS patients from 18.4% to a potential 43.1%.
- The clinical benefit of expanding MT eligibility requires further investigation in clinical trials.
- Stroke code activation criteria influence the generalizability of these findings.
