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Mechanical Thrombectomy in and Outside the REVASCAT Trial

2015; Lippincott Williams & Wilkins; Volume: 46; Issue: 12 Linguagem: Inglês

10.1161/strokeaha.115.011050

1524-4628

Xabier Urra, Sònia Abilleira, Laura Dorado, Marc Ribó, Pere Cardona, Mònica Millán, Ángel Chamorro, Carlos A. Molina, Erik Cobo, Antoni Dávalos, Tudor Jovin, Miquel Gallofré, Joan Martí‐Fàbregas, Raquel Delgado‐Mederos, Alejandro Martínez‐Domeño, Rebeca Marín Bueno, Jaume Roquer, Ana Rodríguez-Campello, Ángel Ois, Elisa Cuadrado‐Godia, E. Giralt, Elío Vivas, Léopoldo Guimaraens, Vı́ctor Obach, Sergio Amaro, Juan Macho, Jordi Blasco, Luís San Román, Antonio López‐Rueda, Antonio Martı́nez-Yélamos, Helena Quesada, Lluis Cano, Lucía Aja, María Ángeles de Miquel, Paloma Mora, Carlos A. Molina, Marta Rubiera, Jorge Pagola, Esteban Santamarina, José Álvarez‐Sabín, Alejandro Tomasello, Pilar Coscojuela, Natàlia Pérez de la Ossa, Meritxell Gomis, Elena López‐Cancio, Carlos Castaño, David Cánovas, Carmen García‐Rodríguez, Jordi Estela, J. Perendreu, Jerzy Krupiński, Sonia Huertas Folch, M. Carme Nicolás Herrerias, Manuel Gómez‐Choco, Sònia García, Raúl Martínez‐Fernández, Francisco Purroy, Jordi Sanahuja, Joaquı́n Serena, Mar Castellanos, Yolanda Silva, Cecile van Eendenburg, Rafael Marés, Anna Pellisé, Xavier Ustrell, Juanjo Baiges, Moisès Garcés, Júlia Saura, Josep Maria Soler Insa, Josep Maria Aragonés, Lola Cocho Calderón, Pilar Otermin Vallejo, Ernest Palomeras,

Venous Thromboembolism Diagnosis and Management

Background and Purpose— Recent trials have shown the superiority of endovascular thrombectomy (EVT) over medical therapy alone in certain stroke patients with proximal arterial occlusion. Using data from the Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke due to Anterior Circulation Large Vessel Occlusion Presenting Within 8-Hours of Symptom Onset (REVASCAT) and a parallel reperfusion treatment registry, we sought to assess the utilization of EVT in a defined patient population, comparing the outcomes of patients treated in and outside the REVASCAT trial. Methods— SONIIA [Sistema Online d’Informació de l’Ictus Agut], a population-based, government-mandated, prospective registry of reperfusion therapies for stroke encompassing the entire population of Catalonia, was used as data source. The registry documents 5 key inclusion criteria of the REVASCAT trial: age, stroke severity, time to treatment, baseline functional status, and occlusion site. We compared procedural, safety, and functional outcomes in patients treated inside and outside the trial. Results— From November 2012 to December 2014, out of 17596 ischemic stroke patients in Catalonia (population 7.5 million), 2576 patients received reperfusion therapies (17/100000 inhabitants-year), mainly intravenous thrombolysis only (2036). From the remaining 540 treated with EVT, 103 patients (out of 206 randomized) were treated within REVASCAT and 437 outside the trial. Of these, 399 did not fulfill some of the study criteria, and 38 were trial candidates (8 treated at REVASCAT centers and 30 at 2 non-REVASCAT centers). The majority of procedural, safety, and functional outcomes were similar in patients treated with EVT within and outside REVASCAT. Conclusions— REVASCAT enrolled nearly all eligible patients representing one third of all patients treated with EVT. Patients treated with EVT within and outside REVASCAT had similar outcomes, reinforcing the therapeutic value of EVT. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01692379.