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Effectiveness of thrombectomy in stroke according to baseline prognostic factors: inverse probability of treatment weighting analysis of a population-based registry

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dc.contributor.author Rudilosso, Salvatore
dc.contributor.author Rodríguez-Campello, Ana
dc.contributor.author Chamorro, Ángel
dc.contributor.author Catalan Stroke Code and Reperfusion Consortium (Cat-SCR)
dc.date.accessioned 2022-11-21T07:36:21Z
dc.date.available 2022-11-21T07:36:21Z
dc.date.issued 2021
dc.identifier.citation Rudilosso S, Ríos J, Rodríguez A, Gomis M, Vera V, Gómez-Choco M, et al. Effectiveness of thrombectomy in stroke according to baseline prognostic factors: inverse probability of treatment weighting analysis of a population-based registry. J Stroke. 2021 Sep; 23(3): 401-10. DOI: 10.5853/jos.2021.00962
dc.identifier.issn 2287-6391
dc.identifier.uri http://hdl.handle.net/10230/54923
dc.description.abstract Background and purpose: in real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods: retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score <6, proximal vertebrobasilar occlusion, supratherapeutic international normalized ratio >3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups' criteria). Results: patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). Conclusions: despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Korean Stroke Society
dc.rights Copyright © 2021 Korean Stroke Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.rights.uri Copyright © 2021 Korean Stroke Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.title Effectiveness of thrombectomy in stroke according to baseline prognostic factors: inverse probability of treatment weighting analysis of a population-based registry
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.5853/jos.2021.00962
dc.subject.keyword Outcome
dc.subject.keyword Prognosis
dc.subject.keyword Propensity score
dc.subject.keyword Registries
dc.subject.keyword Stroke
dc.subject.keyword Thrombectomy
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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