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. 2016 Dec;1(4):264-271.
doi: 10.1177/2396987316667176. Epub 2016 Aug 30.

How many stroke patients might be eligible for mechanical thrombectomy?

Salwa El Tawil  1 , Bharath Cheripelli  1 , Xuya Huang  1 , Fiona Moreton  1 , Dheeraj Kalladka  1 , Niall Jj MacDougal  1 , Ferghal McVerry  1 , Keith W Muir  1
Affiliations

How many stroke patients might be eligible for mechanical thrombectomy?

Salwa El Tawil et al. Eur Stroke J. 2016 Dec.

Abstract

Introduction: Recent studies showed improved patient outcomes with endovascular treatment of acute stroke compared to medical care, including IV rtPA, alone. Seven trials have reported results, each using different clinical and imaging criteria for patient selection. We compared eligibility for different trial protocols to estimate the number of patients eligible for treatment.

Patients and methods: Patient data were extracted from a single centre database that combined patients recruited to three clinical studies, each of which obtained both CTA and CTP within 6 h of stroke onset. The published inclusion and exclusion criteria of seven intervention trials (MR CLEAN, EXTEND-IA, ESCAPE, SWIFT-PRIME, REVASCAT, THERAPY and THRACE) were applied to determine the proportion that would be eligible for each of these studies.

Results: A total of 263 patients was included. Eligibility for IAT in individual trials ranged from 53% to 3% of patients; 17% were eligible for four trials and under 10% for two trials. Only three patients (1%) were eligible for all studies. The most common cause of exclusion was absence of large artery occlusion (LAO) on CTA. When applying simplified criteria requiring an ASPECT score > 6, 16% were eligible for IAT, but potentially 40% of these patients were excluded by perfusion criteria and more than half by common NIHSS thresholds.

Conclusion: Around 15% of patients presenting within 6 h of stroke onset were potentially eligible for IAT, but clinical trial eligibility criteria have much more limited overlap than is commonly assumed and only 1% of patients fulfilled criteria for all recent trials.

Keywords: Ischaemic stroke; acute stroke treatment; mechanical thrombectomy.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The number of patients meeting entry criteria for each of the studies.
Figure 2.
Figure 2.
Numbers of patients eligible for different study combinations. MR: MRCLEAN; TH: Thrace; EX: Extend-IA; ES: ESCAPE RE: REVASCAT; SP: SWIFT-PRIME; TY: Therapy.
Figure 3.
Figure 3.
Number eligible to all studies after applying different clinical and imaging selection criteria. The top panel shows sequential exclusion of patients based on clinical criteria, while the bottom panel shows sequential exclusion of patients based on imaging criteria. Of the eight patients meeting CTP target criteria, only three had a visible clot more than 8 mm, one of the eligibility criteria of THERAPY trial.
Figure 4.
Figure 4.
Number of patients with selected for IAT in a hypothetical clinical setting.
See this image and copyright information in PMC

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