As a result of that interim analysis, the trial was halted because the prespecified efficacy boundary (P<0.0025) had been exceeded. The statistical analysis plan specified one-sided hypothesis testing for the Wilcoxon rank-sum test and a P value of less than 0.025 as a measure of statistical significance, but we report two-sided results and use a P value of less than 0.05 as a measure of statistical significance. Adjusted treatment effects and P values for the primary efficacy outcome were calculated with the use of ordinal regression on the full modified Rankin scale and stratified Cochran–Mantel–Haenszel tests, with the randomization stratification variables split at their medians as the covariates. For patients lost to follow-up at 90 days, the missing 90-day score on the modified Rankin scale was imputed from the 30-day score by the last-observation-carried-forward method.
Thrombectomy
This minimally invasive technique involves the use of catheters and specialized devices to physically extract or dissolve the clot.
Thrombectomy is an important treatment option for eligible patients experiencing acute ischemic stroke, often in combination with other therapies like thrombolytic drugs.
Effectiev thrombectomy can significantly improve outcomes and reduce disability for those suffering from life-threatening clots.
Researchers can use PubCompare.ai's AI-driven platform to optimize thrombectomy research protocols, locate the best published methods, and enhance the reproducubility and accuracy of their work.
Most cited protocols related to «Thrombectomy»
The proportions of patients who were (1) disabled, (2) dead/disabled, (3) dead from all causes, and (4) dead from index‐stroke‐related causes at 1, 2, 3, 4, and 5 years were calculated and categorized according to the 3‐month mRS (or the mRS between 1 and 3 months if the 3‐month mRS was missing). Logistic regression was used to adjust the associations of 3‐month mRS and long‐term outcomes for age and sex. Survival to 5 years after index stroke was assessed using Kaplan‐Meier techniques categorized according to 3‐month mRS. Differences in survival in relation to 3‐month mRS scores were assessed using age‐ and sex‐adjusted Cox proportional hazards models.
Treatable major strokes or nonhyperacute/minor strokes: The former were defined as patients seeking medical attention within 6 hours of symptom onset, presenting either to hospital or emergency services with National Institutes of Health Stroke Scale ≥5. These were “minimal criteria” to capture the subset that have been the focus of hyperacute stroke trials and would potentially be eligible for thrombolysis/thrombectomy.
Atrial fibrillation (AF)‐related or non‐AF‐related strokes: The former were defined as patients with a prestroke diagnosis of AF or AF at presentation, meeting criteria for cardioembolic etiology per the TOAST trial (Trial of Org 10172 in Acute Stroke Treatment) classification system.
Lacunar or nonlacunar strokes: Classified by TOAST criteria for small‐vessel occlusion.
Statistical analyses were performed using STATA 13.1 (Statacorp, College Station, TX).
Distribution of patient admission infrastructure
Infrastructure | County | Staff |
---|---|---|
Emergency department | Rhône (69) | 7 |
Ain (01) | 3 | |
Saône-et-Loire (71) | 6 | |
Isère (38) | 7 | |
Loire (42) | 6 | |
PSC | Rhône (69) | 2 |
Ain (01) | 1 | |
Saône-et-Loire (71) | 1 | |
Isère (38) | 2 | |
Loire (42) | 2 | |
CSC | Rhône (69) | 1 |
Ain (01) | 0 | |
Saône-et-Loire (71) | 0 | |
Isère (38) | 1 | |
Loire (42) | 1 |
Although it is pertinent to characterise the area according to the time required for travel from any point in the network to the treatment facility, it is even more interesting to model overall admission time. Treatment of stroke requires the best possible upstream taking in hand of the patient [4 (link), 38 (link)]. This means that it is necessary to know the pattern of the territory according to the type of transport and also the positions of stroke treatment facilities. In our case, the development of thrombectomy and recent studies have shown its advantages for patients [39 (link)–41 (link)] and modelling overall patient reception was performed using the location of the CSC. With this model it is possible to characterize the territory by care delays from the emergency call to the admission in nearest CSC. It is a global approach of care because all the times of pre-hospital emergency care for stroke patients are taken into account. The second phase of our study was therefore aimed at georeferencing each fire station in the Rhône and neighbouring counties, together with each SMUR team, using their precise addresses. After this georeferencing, supply zones were calculated for these facilities and then for each CSC to finally show total admission time—i.e. the estimated times from SMUR centres or fire stations to all the points in the network and then from any point to the CSC (Fig.
Diagrammatic representation of overall journey time modelled according to the type of transport (SMUR and fire brigade)
Most recents protocols related to «Thrombectomy»
Since September 2019, Viz LVO has been implemented in all MSHS facilities (PCSs and CSCs); however, PSCs outside our system lack this AI-driven tool. Viz LVO is an FDA-cleared AI-powered software that provides computer-assisted triage of suspected LVOs on CTA scans. Viz LVO is trained to identify LVOs in the supraclinoid internal carotid artery (ophthalmic, choroidal, and communicating segments) and the M1 (horizontal part) of the MCA. However, it does not assess the extracranial circulation, the posterior circulation, or the infraclinoid internal carotid artery [7] . In instances where a partial or complete occlusion is suspected, or when a vessel's caliber is less than the reference threshold, an LVO is suspected, and an alert is automatically sent to the stroke team [8] (link). For every CTA scan that is processed by Viz, a positive or negative LVO notification is provided, rather than the exact location of the occlusion.
For the purposes of this study, our institutional stroke database was reviewed in order to identify all suspected/confirmed LVO patients transferred from PSCs within and outside of our healthcare system from January 2020 to December 2021. Data collected included age, gender, ethnicity, race, rates of intravenous thrombolysis and mechanical thrombectomy, baseline modified Rankin Scale (mRS) score, presenting National Institutes of Health Stroke Scale (NIHSS), and initial Alberta Stroke Program Early CT Score (ASPECTS). Primary outcomes included peripheral arrival to peripheral CTA, transfer time, and all available time metrics from peripheral CTA.
The “Viz-transfers” group includes all LVO transfers from PSCs within our system (3 spoke hospitals), while the “Non-Viz-transfers” group (control group) is comprised of all LVO transfers from PSCs that are MSHS-affiliated but belong outside of our system (4 spoke hospitals). Spokes within MSHS are empowered with Viz, while spokes outside MSHS are not Viz-empowered. For non-MSHS spokes, interventional neuroradiology (INR) team notification time after CTA depends on how fast radiology and stroke teams diagnose the LVO. For MSHS spokes, post-CTA INR team notification is instantaneous when an LVO is suspected by Viz. To minimize confounding, contemporaneous LVO transfers within and outside the MSHS were compared. Patients that were placed on an “LVO watch” due to mild symptoms were excluded. Patients with missing time metrics were also excluded. This study was approved by our local IRB with waiver of informed consent.
Since its approval in 2019, the program has operated as a modified hub-and-spoke model. It receives funding from the Mexican government through the ISSSTE healthcare system and has access to ambulance services available 24/7. It also includes a stroke telemedicine network to facilitate the evaluation and care of potential patients.
As mentioned above, the program's functioning is mainly based on the hub-and-spoke model but with certain adequations to the Mexican Healthcare system. For example, most hub-and-spoke models function by offering daytime AS treatment at local centers, and the patients in need of treatment out-of-hours and on weekends are treated at hub hospitals. But, in the “ResISSSTE Cerebro” program, all centers provide AS treatment regardless of time or day, with the only difference being that advanced modalities of treatment (EVT and IVT guided by perfusion imaging up to 9 h after the onset of symptoms) are available only at the ASC. Similarly, the drip-and-ship model, as initially conceived, assumes that all centers within a network can diagnose LVO, thus allowing emergency medical services (EMS) to move patients to the closest hospital and only transfer to a thrombectomy-ready hospital for those patients with confirmed LVO. The drip-and-ship model was only partially implemented in our program due to constrained access to ambulances and human and technological infrastructure to perform advanced imaging in stroke patients at the ESC. Our model also accommodates that most of the patients in Mexico arrive at a hospital by their means (for example, the family car or public transportation), with few coming by EMS; therefore, prenotification is uncommon. Consequently, by concentrating the human and technological resources in a single center, the “ResISSSTE Cerebro” program can deliver advanced AS treatment 24/7 while preserving the capability of ESC to provide telemedicine supervised IVT also 24/7.
The stroke telemedicine network utilizes an instant messaging app that includes all the emergency room staff of all shifts grouped by each ESC. Each group, in turn, has all the stroke team members located at the ASC. Emergency room physicians are in charge of all initial evaluations and are responsible for alerting the stroke team and carrying out their instructions regarding treatment. At the same time, they order the NCCT and arrange for a possible transfer to the ASC. The ESC prenotifies all transfers to ASC. The protocol is known by all the staff at the emergency rooms of the ESC, and a print or electronic copy is available for consultation at the office of the head of the emergency department.
Top products related to «Thrombectomy»
More about "Thrombectomy"
This procedure involves the use of catheters and specialized devices, such as the Trevo Retriever, Solitaire stent retriever, and Wallstent, to physically extract or dissolve the clot.
Thrombectomy is an important treatment option for eligible patients experiencing acute ischemic stroke, often in combination with other therapies like thrombolytic drugs (e.g., tPA).
Effective thrombectomy can significantly improve outcomes and reduce disability for those suffering from life-threatening clots.
Researchers can use PubCompare.ai's AI-driven platform to optimize thrombectomy research protocols, locate the best published methods (including pre-prints and patents), and enhance the reproducibility and accuracy of their work using tools like SPSS software version 25.0.
PubCompare.ai's cutting-edge technology can help researchers discover the latest advancements in thrombectomy procedures, such as the Trevo ProVue and Solitaire AB/FR devices, to improve patient care and outcomes.