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Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry
BACKGROUND: Endovascular treatment (EVT) for acute ischemic stroke (AIS) is performed in intervention centers that provide the full range of neuro(endo)vascular care (level 1) and centers that only perform EVT for AIS (level 2). We compared outcomes between these center types and assessed whether di...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10069206/ https://www.ncbi.nlm.nih.gov/pubmed/37021181 http://dx.doi.org/10.1177/23969873221145771 |
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author | Olthuis, Susanne GH Hinsenveld, Wouter H Pinckaers, Florentina ME Amini, Marzyeh Lingsma, Hester F Staals, Julie HCML Schreuder, Tobien Schonewille, Wouter J Yo, Lonneke SF BWEM Roos, Yvo Postma, Alida A Dippel, Diederik WJ van Zwam, Wim H van Oostenbrugge, Robert J de Ridder, Inger R |
author_facet | Olthuis, Susanne GH Hinsenveld, Wouter H Pinckaers, Florentina ME Amini, Marzyeh Lingsma, Hester F Staals, Julie HCML Schreuder, Tobien Schonewille, Wouter J Yo, Lonneke SF BWEM Roos, Yvo Postma, Alida A Dippel, Diederik WJ van Zwam, Wim H van Oostenbrugge, Robert J de Ridder, Inger R |
author_sort | Olthuis, Susanne GH |
collection | PubMed |
description | BACKGROUND: Endovascular treatment (EVT) for acute ischemic stroke (AIS) is performed in intervention centers that provide the full range of neuro(endo)vascular care (level 1) and centers that only perform EVT for AIS (level 2). We compared outcomes between these center types and assessed whether differences in outcomes could be explained by center volume (CV). PATIENTS AND METHODS: We analyzed patients included in the MR CLEAN Registry (2014–2018), a registry of all EVT-treated patients in the Netherlands. Our primary outcome was the shift on the modified Rankin scale (mRS) after 90 days (ordinal regression). Secondary outcomes were the NIHSS 24–48 h post-EVT, door-to-groin time (DTGT), procedure time (linear regression), and recanalization (binary logistic regression). We compared outcomes between level 1 and 2 centers using multilevel regression models, with center as random intercept. We adjusted for relevant baseline factors, and in case of observed differences, we additionally adjusted for CV. RESULTS: Of the 5144 patients 62% were treated in level 1 centers. We observed no significant differences between center types in mRS (adjusted(a)cOR: 0.79, 95% CI: 0.40 to 1.54), NIHSS (aβ: 0.31, 95% CI: −0.52 to 1.14), procedure duration (aβ: 0.88, 95% CI: −5.21 to 6.97), or DTGT (aβ: 4.24, 95% CI: −7.09 to 15.57). The probability for recanalization was higher in level 1 centers compared to level 2 centers (aOR 1.60, 95% CI: 1.10 to 2.33), and this difference probably depended on CV. CONCLUSIONS: We found no significant differences, that were independent of CV, in the outcomes of EVT for AIS between level 1 and level 2 intervention centers. |
format | Online Article Text |
id | pubmed-10069206 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-100692062023-04-04 Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry Olthuis, Susanne GH Hinsenveld, Wouter H Pinckaers, Florentina ME Amini, Marzyeh Lingsma, Hester F Staals, Julie HCML Schreuder, Tobien Schonewille, Wouter J Yo, Lonneke SF BWEM Roos, Yvo Postma, Alida A Dippel, Diederik WJ van Zwam, Wim H van Oostenbrugge, Robert J de Ridder, Inger R Eur Stroke J Original Research Articles BACKGROUND: Endovascular treatment (EVT) for acute ischemic stroke (AIS) is performed in intervention centers that provide the full range of neuro(endo)vascular care (level 1) and centers that only perform EVT for AIS (level 2). We compared outcomes between these center types and assessed whether differences in outcomes could be explained by center volume (CV). PATIENTS AND METHODS: We analyzed patients included in the MR CLEAN Registry (2014–2018), a registry of all EVT-treated patients in the Netherlands. Our primary outcome was the shift on the modified Rankin scale (mRS) after 90 days (ordinal regression). Secondary outcomes were the NIHSS 24–48 h post-EVT, door-to-groin time (DTGT), procedure time (linear regression), and recanalization (binary logistic regression). We compared outcomes between level 1 and 2 centers using multilevel regression models, with center as random intercept. We adjusted for relevant baseline factors, and in case of observed differences, we additionally adjusted for CV. RESULTS: Of the 5144 patients 62% were treated in level 1 centers. We observed no significant differences between center types in mRS (adjusted(a)cOR: 0.79, 95% CI: 0.40 to 1.54), NIHSS (aβ: 0.31, 95% CI: −0.52 to 1.14), procedure duration (aβ: 0.88, 95% CI: −5.21 to 6.97), or DTGT (aβ: 4.24, 95% CI: −7.09 to 15.57). The probability for recanalization was higher in level 1 centers compared to level 2 centers (aOR 1.60, 95% CI: 1.10 to 2.33), and this difference probably depended on CV. CONCLUSIONS: We found no significant differences, that were independent of CV, in the outcomes of EVT for AIS between level 1 and level 2 intervention centers. SAGE Publications 2022-12-22 2023-03 /pmc/articles/PMC10069206/ /pubmed/37021181 http://dx.doi.org/10.1177/23969873221145771 Text en © European Stroke Organisation 2022 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Articles Olthuis, Susanne GH Hinsenveld, Wouter H Pinckaers, Florentina ME Amini, Marzyeh Lingsma, Hester F Staals, Julie HCML Schreuder, Tobien Schonewille, Wouter J Yo, Lonneke SF BWEM Roos, Yvo Postma, Alida A Dippel, Diederik WJ van Zwam, Wim H van Oostenbrugge, Robert J de Ridder, Inger R Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry |
title | Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry |
title_full | Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry |
title_fullStr | Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry |
title_full_unstemmed | Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry |
title_short | Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry |
title_sort | association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: results from the mr clean registry |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10069206/ https://www.ncbi.nlm.nih.gov/pubmed/37021181 http://dx.doi.org/10.1177/23969873221145771 |
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