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Original research
Mechanical thrombectomy performs similarly in real world practice: a 2016 nationwide study from the Czech Republic
  1. Ondrej Volny1,2,
  2. Antonin Krajina3,
  3. Silvie Belaskova2,
  4. Michal Bar4,
  5. Petra Cimflova3,5,
  6. Roman Herzig6,
  7. Daniel Sanak7,
  8. Ales Tomek8,
  9. Martin Köcher9,
  10. Miloslav Rocek10,
  11. Radek Padr10,
  12. Filip Cihlar11,
  13. Miroslava Nevsimalova12,
  14. Lubomir Jurak13,
  15. Roman Havlicek14,
  16. Martin Kovar15,
  17. Petr Sevcik16,
  18. Vladimir Rohan16,
  19. Jan Fiksa17,
  20. Bijoy K Menon18,
  21. Robert Mikulik1,2
  1. 1Department of Neurology, St Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
  2. 2International Clinical Research Centre, Stroke Research Program, St Anne’s University Hospital, Brno, Czech Republic
  3. 3Department of Radiology, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
  4. 4Department of Neurology, University Hospital Ostrava, Faculty of Medicine, University Ostrava, Ostrava, Czech Republic
  5. 5Department of Medical Imaging, St Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
  6. 6Department of Neurology, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
  7. 7Department of Neurology, Palacky University Medical School, Olomouc, Czech Republic
  8. 8Department of Neurology, Charles University, 2nd Medical Faculty, Prague, Czech Republic
  9. 9Department of Radiology, University Hospital and Palacky, University Medical School, Olomouc, Czech Republic
  10. 10Department of Radiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Usti nad Labem, Czech Republic
  11. 11Department of Radiology, Masaryk Hospital, Usti nad Labem, Czech Republic
  12. 12Department of Neurology, Hospital Ceske Budejovice, Statutory City, Czech Republic
  13. 13Neurocentre, Regional Hospital Liberec, Liberec, Czech Republic
  14. 14Department of Neurology, Military University Hospital, Prague, Canada
  15. 15Department of Neurology, Na Homolce Hospital, Prague, Czech Republic
  16. 16Department of Neurology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
  17. 17Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
  18. 18Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
  1. Correspondence to Dr Ondrej Volny, Department of Neurology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, 53 Pekarska, 602 00 Brno, Czech Republic; 214565{at}mail.muni.cz

Abstract

Background Randomized clinical trials have proven mechanical thrombectomy (MT) to be a highly effective and safe treatment in acute stroke. The purpose of this study was to compare neurothrombectomy data from the Czech Republic (CR) with data from the HERMES meta-analysis.

Methods Available nationwide data for the CR from 2016 from the Safe Implementation of Treatments in Stroke–Thrombectomy (SITS-TBY) registry for patients with terminal internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusions were compared with data from HERMES. CR and HERMES patients were comparable in age, sex, and baseline National Institutes of Health Stroke Scale scores.

Results From a total of 1053 MTs performed in the CR, 845 (80%) were reported in the SITS-TBY. From these, 604 (72%) were included in this study. Occlusion locations were as follows (CR vs HERMES): ICA 22% versus 21% (P=0.16), M1 MCA 62% versus 69% (P=0.004), and M2 MCA 16% versus 8% (P<0.0001). Intravenous thrombolysis was given to 76% versus 83% of patients, respectively (P=0.003). Median onset to reperfusion times were comparable: 232 versus 285 min, respectively (P=0.66). A modified Thrombolysis in Cerebral Infarction score of 2b/3 was achieved in 74% (433/584) versus 71% (390/549) of patients, respectively (OR 1.17, 95% CI 0.90–1.5, P=0.24). There was no statistically significant difference in the percentage of parenchymalhematoma type 2 (OR 1.12, 95% CI 0.66–1.90, P=0.68). A modified Rankin Scale score of 0–2 at 3 months was achieved in 48% (184/268) versus 46% (291/633) of patients, respectively (OR 0.92, 95% CI 0.71–1.18, P=0.48).

Conclusions Data on efficacy, safety, and logistics of MT from the CR were similar to data from the HERMES collaboration.

  • stroke
  • thrombectomy
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Footnotes

  • Contributors OV, RM, and BKM: substantial contributions to the conception or design of the work; the acquisition, analysis, and interpretation of the data; drafting the work and revising it critically for important intellectual content. SB: analysis and interpretation of the data. AK, MB, PC, RH, DS, AT, MK, MR, RP, FC, MN, LJ, RH, VR, MK, PS, and JF: data acquisition, drafting the work and revising it critically for important intellectual content.

  • Funding This work was supported by National Program of Sustainability II, Czech Republic, grant No LQ1605.

  • Competing interests None declared.

  • Ethics approval The study was approved by the local institutional review boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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