Trends in revascularization therapies for patients with acute stroke with large infarcts: A population-based study

Background Evidence from randomized clinical trials shows that mechanical thrombectomy (MT) enhances functional outcomes in patients with large core ischemic stroke. Objective To evaluate trends in the use of revascularization therapies, particularly MT, and their impact on functional outcomes in pa...

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Detalles Bibliográficos
Autores: Doncel Moriano, Antonio, Rodríguez Vázquez, Alejandro, Rosa, Irene, Rudilosso, Salvatore, Serrano Clerencia, Mònica, Renú, Arturo, Cabero Arnold, Andrea, Blasco, Jordi, Amaro Delgado, Sergio, Llull Estrany, Laura, Molina, Carlos A., Cardona Portela, Pere, Camps Renom, Pol, Millán, Mónica, Figueras Aguirre, Georgina, Rodríguez Campello, Ana, Silva, Yolanda, Purroy, Francisco, Salvat, Mercè, Vargas, Martha, Urra, Xabier, Chamorro Sánchez, Ángel
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2025
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/225087
Acceso en línea:https://hdl.handle.net/2445/225087
Access Level:acceso abierto
Palabra clave:Embòlia i trombosi cerebral
Terapèutica
Cerebral embolism and thrombosis
Therapeutics
Descripción
Sumario:Background Evidence from randomized clinical trials shows that mechanical thrombectomy (MT) enhances functional outcomes in patients with large core ischemic stroke. Objective To evaluate trends in the use of revascularization therapies, particularly MT, and their impact on functional outcomes in patients with large core ischemic stroke in routine clinical settings. Methods Observational data from the Stroke Code Registry of Catalonia (CICAT, 2016–2024) were analyzed. Patients with anterior circulation ischemic stroke and Alberta Stroke Program Early CT Score (ASPECTS) <6, whether treated with reperfusion therapies or not, were included. Statistical analyses included trend analysis and multivariable logistic regression to identify predictors of favorable outcomes (modified Rankin Scale score 0–3 at 90 days) and mortality. Results Among 599 patients, MT use increased significantly from 22% pre-2022 to 36% post-2022. This increase was associated with improved functional outcomes, with favorable outcomes rising from 29% to 43% post-2022. MT was a significant independent predictor of favorable outcomes (OR 3.4, 95% CI 2.1 to 5.5) and reduced mortality (OR 0.46, 95% CI 0.32 to 0.68). Intravenous thrombolysis also improved outcomes (OR 2.1, 95% CI 1.3 to 3.5). The benefit of MT was consistent across ASPECTS subgroups (0–2 and 3–5). Mediation analysis indicated that 88% of improvement could be attributed to increased MT use. Conclusions Increased MT use significantly improved outcomes for patients with large core ischemic stroke, particularly after 2022. Benefits were observed across subgroups, including those with very low ASPECTS. These findings support broadening MT access and suggest the need to update treatment guidelines to consider patients with large ischemic cores, aiming to optimize outcomes in routine clinical practice.

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