Background and Purpose: The rapid evolution of endovascular therapy (EVT) in acute ischemic stroke has benefited its performance in real clinical practice. The aim of this study is to describe the annual trends of EVT performance after the introduction of the stentriever in Korea.
Methods: Data were retrospectively collected from the ASIAN KR (Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention - Korean Retrospective) registry between January 2011 and December 2015. The ASIAN KR registry is an observational multicenter registry of consecutive patients treated with EVT for acute ischemic stroke. Trends in EVT performance were described and analyzed.
Results: A total of 649 patients were included for analysis. The target arterial occlusive lesions included 584 in the anterior circulation (including 158 ICA terminuses and 293 MCA M1s) and 65 in the posterior circulation. Overall, successful reperfusion (mTICI 2b-3, post-procedure) and favorable outcome (mRS 0-2 or equal to prestroke mRS, at 3-month) was achieved in 500 patients (77.0%) and 332 patients (51.2%), respectively. A trend for increase in successful reperfusion and favorable outcome over time was observed (73.9% in 2011 vs. 83.1% in 2015, p=0.040; 48.7% in 2011 vs. 58.1% in 2015, p=0.074). Utilization of a stentriever as a first-chosen device for EVT increased over time from 12.8% in 2011 to 46.9% in 2015 (p<0.001). This was accompanied by a significant trend for shorter time regarding arrival to groin puncture and groin puncture to end of EVT procedure (median 119 minutes in 2011 vs. 86 minutes in 2015, p<0.001; 68 minutes in 2011 vs. 54.5 minutes in 2015, p<0.001). After adjustment for age, onset to groin puncture time, and successful reperfusion, a trend for better clinical outcome over time following EVT remained statistically significant (odds ratio 1.13, 95% CI 1.01-1.27; p=0.033)
Conclusions: A upward trend in successful reperfusion and better clinical outcome was observed along with improvement in intra-hospital workflow and utilization of up-to-date thrombectomy devices over time, which emphasizes the role of EVT experience, quality improvement of workflow, and use of newer EVT devices.