Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China-Reference-Cited by-同舟云学术

Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China

Published:2021-04 Issue:4 Volume:52 Page:1203-1212
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Jia Baixue¹,Ren Zeguang²,Mokin Maxim²^ORCID,Burgin W. Scott²^ORCID,Bauer Clayton T.²,Fiehler Jens³,Mo Dapeng¹,Ma Ning¹,Gao Feng¹,Huo Xiaochuan¹,Luo Gang¹,Wang Anxin⁴,Pan Yuesong⁴^ORCID,Song Ligang¹,Sun Xuan¹,Zhang Xuelei¹,Gui Liqiang⁵,Song Cunfeng⁶,Peng Ya⁷,Wu Jin⁸,Zhao Shijun⁹,Zhao Junfeng¹⁰,Zhou Zhiming¹¹,Li Yongli¹²,Jing Ping¹³,Yang Lei¹⁴,Liu Yajie¹⁵,Zhao Qingshi¹⁶,Liu Yan¹⁷,Peng Xiaoxiang¹⁸,Gao Qingchun¹⁹,Guo Zaiyu²⁰,Chen Wenhuo²¹^ORCID,Li Weirong²²,Cheng Xiaojiang²³,Xu Yun²⁴^ORCID,Zhang Yongqiang²⁵,Zhang Guilian²⁶,Lu Yijiu²⁷,Lu Xinyu²⁸,Wang Dengxiang²⁹,Wang Yan³⁰,Li Hao³¹,Ling Li³²,Peng Guangge¹,Zhang Jingyu¹,Zhang Kai¹,Li Shuo¹,Qi Zhongqi¹,Xu Haifeng¹,Tong Xu¹^ORCID,Ma Gaoting¹,Liu Raynald¹,Guo Xu³³^ORCID,Deng Yiming¹,Leng Xinyi³⁴^ORCID,Leung Thomas W.³⁴^ORCID,Liebeskind David S.³⁵^ORCID,Wang Yilong³⁶³⁷^ORCID,Wang Yongjun^ORCID,Miao Zhongrong¹^ORCID,Hua Yang,Geng Deqin,Yuan Haicheng,Wang Hongwei,Yang Haihua,Wang Zengwu,Wei Liping,Liufu Xuancong,Shi Xiangqun,Li Juntao,Yang Wenwu,Jing Wenji,Yong Xiang,Wang Leyuan,Li Chunlei,Cao Yibin,Zhu Qingfeng,Zhang Peng,Luo Xiang,Chen Shengli,Peng WenWu,Wang Lixin,Wen Xue,Shi Shugui,Wang Wanming,Bo Wang,Yuan Pu,Wang Dong,Guan Haitao,Liang Wenbao,Ma Daliang,Chen Long,Xiao Yan,Xie Xiangdong,Shi Zhonghua,Zeng Xiangjun,Su Fanfan,Chang MingZe,Yin Jijun,Sun Hongxia,Li Chong,Bi Yong,Xie Gang,Zhao Yuwu,Wang Chao,Zhang Peng,Wang Xianjun,Li Dongqun,Liang Hui,Chen Zhonglun,Wang Yu Xin,Yin Lin,Qiu HongKai,Wei Jun,Sun Yaxuan,Feng Xiaoya,Wu Weihua,Gao Lianbo,Ai Zhibing,Lan Tan,Ding Li,Liang Qilong,Wang Zhimin,Yang Jianwen,Xu Ping,Dong Wei,Zheng Quanle,Zhu Zhenyun,Zhao Liyue,Meng Qingbo,Wei Yuqing,Chen Xianglin,Wang Wei,Sun Dong,Yan Yongxing,Yuan Guangxiong,Yang Yadong,Zhou Jianfeng,Yang Zhi,Zhang Zhenzhong,Guan Ning,Wang Huihong

Affiliation:

1. Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University.

2. Department of Neurosurgery, University of South Florida (Z.R., M.M., W.S.B., C.T.B.).

3. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.F.).

4. China National Clinical Research Center for Neurological Diseases (A.W., Y. Pan), Beijing Tiantan Hospital, Capital Medical University.

5. Department of Interventional Neuroradiology, Langfang Changzheng Hospital, China (L.G.).

6. Department of Interventional Neuroradiology, Liaocheng Third People’s Hospital, China (C.S.).

7. Department of Neurosurgery, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, China (Y. Peng).

8. Department of Neurology, Second Affiliated Hospital of Nanjing Medical University, China (J.W.).

9. Department of Interventional Radiology, Fengrun District People’s Hospital of Tangshan City, China (S.Z.).

10. Department of Neurology, SiPing Central People’s Hospital, China (J. Zhao).

11. Department of Neurology, Yijishan Hospital of Wannan Medical College, China (Z.Z.).

12. Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, China (Y. Li).

13. Department of Neurology, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, China (P.J.).

14. Department of Neurosurgery, The First Hospital of Shijiazhuang, China (L.Y.).

15. Department of Neurology, Shenzhen Hospital of Southern Medical University, China (Yajie Liu).

16. Department of Neurology, The People’s Hospital of Longhua, China (Q.Z.).

17. Department of Neurology, Jingjiang People’s Hospital, The Seventh Affiliated Hospital of Yangzhou University, China (Yan Liu).

18. Department of Neurology, Hubei Third People’s Hospital, China (X.P.).

19. Department of Neurology, Institute of Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, China (Q.G.).

20. Department of Neurosurgery, Tianjin TEDA Hospital, China (Z.G.).

21. Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, China (W.C.).

22. Department of Neurology, Taiyuan Central Hospital, China (W.L.).

23. Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, China (X.C.).

24. Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, China (Y.X.).

25. Department of Neurosurgery, Wenling First People’s Hospital, China (Y.Z.).

26. Department of Neurology, The Second Affiliated Hospital of Xi’an Jiaotong University, China (G.Z.).

27. Department of Internal Neurology, The First People’s Hospital of Yulin, China (Y. Lu).

28. Department of Neurosurgery, Zhenjiang First People’s Hospital, China (X. Lu).

29. Department of Neurology, Qitaihe Coal General Hospital, China (D.W.).

30. Stroke Center, People’s Hospital of Tangshan City, China (Yan Wang).

31. Department of Neurology, Affiliated Hospital Guilin Medical University, China (H.L.).

32. Department of Neurology, The Affiliated Hospital of Hebei University, China (L.L.).

33. Department of Neurointervetion, Beijing Anzhen Hospital, Capital Medical University, China (X.G.).

34. Department of Medicine and Therapeutics, Chinese University of Hong Kong, China (X. Leng, T.W.L.).

35. Department of Neurology, University of California (D.S.L.).

36. Department of Neurology, China National Clinical Research Center for Neurological Diseases, Tiantan Clinical Trial and Research Center for Stroke (Yilong Wang), Beijing Tiantan Hospital, Capital Medical University.

37. Beijing Tiantan Hospital, Capital Medical University, China (Yongjun Wang).

Abstract

Background and Purpose: The benefit of endovascular treatment (EVT) for large vessel occlusion in clinical practice in developing countries like China needs to be confirmed. The aim of the study was to determine whether the benefit of EVT for acute ischemic stroke in randomized trials could be generalized to clinical practice in Chinese population. Methods: We conducted a prospective registry of EVT at 111 centers in China. Patients with acute ischemic stroke caused by imaging-confirmed intracranial large vessel occlusion and receiving EVT were included. The primary outcome was functional independence at 90 days defined as a modified Rankin Scale score of 0 to 2. Outcomes of specific subgroups in the anterior circulation were reported and logistic regression was performed to predict the primary outcome. Results: Among the 1793 enrolled patients, 1396 (77.9%) had anterior circulation large vessel occlusion (median age, 66 [56–73] years) and 397 (22.1%) had posterior circulation large vessel occlusion (median age, 64 [55–72] years). Functional independence at 90 days was reached in 45% and 44% in anterior and posterior circulation groups, respectively. For anterior circulation population, underlying intracranial atherosclerotic disease was identified in 29% of patients, with higher functional independence at 90 days (52% versus 44%; P =0.0122) than patients without intracranial atherosclerotic disease. In the anterior circulation population, after adjusting for baseline characteristics, procedure details, and early outcomes, the independent predictors for functional independence at 90 days were age <66 years (odds ratio [OR], 1.733 [95% CI, 1.213–2.476]), time from onset to puncture >6 hours (OR, 1.536 [95% CI, 1.065–2.216]), local anesthesia (OR, 2.194 [95% CI, 1.325–3.633]), final modified Thrombolysis in Cerebral Infarction 2b/3 (OR, 2.052 [95% CI, 1.085–3.878]), puncture-to-reperfusion time ≤1.5 hours (OR, 1.628 [95% CI, 1.098–2.413]), and National Institutes of Health Stroke Scale score 24 hours after the procedure <11 (OR, 9.126 [95% CI, 6.222–13.385]). Conclusions: Despite distinct characteristics in the Chinese population, favorable outcome of EVT can be achieved in clinical practice in China. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03370939.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

Link

https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.031869

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