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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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:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat: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
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spelling Trends in revascularization therapies for patients with acute stroke with large infarcts: A population-based studyDoncel Moriano, AntonioRodríguez Vázquez, AlejandroRosa, IreneRudilosso, SalvatoreSerrano Clerencia, MònicaRenú, ArturoCabero Arnold, AndreaBlasco, JordiAmaro Delgado, SergioLlull Estrany, LauraMolina, Carlos A.Cardona Portela, PereCamps Renom, PolMillán, MónicaFigueras Aguirre, GeorginaRodríguez Campello, AnaSilva, YolandaPurroy, FranciscoSalvat, MercèVargas, MarthaUrra, XabierChamorro Sánchez, ÁngelEmbòlia i trombosi cerebralTerapèuticaCerebral embolism and thrombosisTherapeuticsBackground 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.BMJ Publishing Group2025202520252025info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersion33 p.application/pdfhttps://hdl.handle.net/2445/225087Articles publicats en revistes (Medicina)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésVersió postprint del document publicat a: https://doi.org/10.1136/jnis-2025-023252Journal of Neurointerventional Surgery, 2025, vol. 17, num.10, p. 1059-1065https://doi.org/10.1136/jnis-2025-023252cc-by-nc (c) Doncel-Moriano Cubero, A. et al., 2025http://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/2250872026-05-29T05:05:01Z
dc.title.none.fl_str_mv Trends in revascularization therapies for patients with acute stroke with large infarcts: A population-based study
title Trends in revascularization therapies for patients with acute stroke with large infarcts: A population-based study
spellingShingle Trends in revascularization therapies for patients with acute stroke with large infarcts: A population-based study
Doncel Moriano, Antonio
Embòlia i trombosi cerebral
Terapèutica
Cerebral embolism and thrombosis
Therapeutics
title_short Trends in revascularization therapies for patients with acute stroke with large infarcts: A population-based study
title_full Trends in revascularization therapies for patients with acute stroke with large infarcts: A population-based study
title_fullStr Trends in revascularization therapies for patients with acute stroke with large infarcts: A population-based study
title_full_unstemmed Trends in revascularization therapies for patients with acute stroke with large infarcts: A population-based study
title_sort Trends in revascularization therapies for patients with acute stroke with large infarcts: A population-based study
dc.creator.none.fl_str_mv 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
author Doncel Moriano, Antonio
author_facet 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
author_role author
author2 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
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Embòlia i trombosi cerebral
Terapèutica
Cerebral embolism and thrombosis
Therapeutics
topic Embòlia i trombosi cerebral
Terapèutica
Cerebral embolism and thrombosis
Therapeutics
description 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.
publishDate 2025
dc.date.none.fl_str_mv 2025
2025
2025
2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/225087
url https://hdl.handle.net/2445/225087
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Versió postprint del document publicat a: https://doi.org/10.1136/jnis-2025-023252
Journal of Neurointerventional Surgery, 2025, vol. 17, num.10, p. 1059-1065
https://doi.org/10.1136/jnis-2025-023252
dc.rights.none.fl_str_mv cc-by-nc (c) Doncel-Moriano Cubero, A. et al., 2025
http://creativecommons.org/licenses/by-nc/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by-nc (c) Doncel-Moriano Cubero, A. et al., 2025
http://creativecommons.org/licenses/by-nc/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 33 p.
application/pdf
dc.publisher.none.fl_str_mv BMJ Publishing Group
publisher.none.fl_str_mv BMJ Publishing Group
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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