Acute Endovascular Stroke Treatment in Germany in 2019

Abstract

Purpose Since the incidental discovery and systematic introduction of mechanical endovascular stroke treatment in 2015 there are few reports about the real-life situation in daily clinical practice. The aim of this study was to evaluate the mechanical thrombectomy data documented in the quality assurance database of the German Society\xa0for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society of Neuroradiology (DGNR) in 2019. Methods We retrospectively analyzed the clinical and procedural data of all mechanical thrombectomies that were entered into the voluntary nationwide database in 2019. The information of each procedure was provided on a\xa0standardized web-based data sheet. Data were exported and analyzed by a\xa0group of experts on behalf of the DGNR. Results A\xa0total of 13,840 data sets from 158 participating centers could be analyzed. Mean age of the patients was 74\u202f±\u200913\xa0years; 53.9% were female. Vessel occlusion was located in the anterior circulation in 87.4%, in the posterior circulation in 10.7%. On hospital admission, the median National Institutes of Health Stroke Scale (NIHSS) was 14 (lower/upper quartile 10/19); at hospital discharge, median NIHSS had dropped to 9 (lower/upper quartile 2/12; p \u202f<\u202f0.001). Recanalization of the occluded vessel segment was successful (TICI 2b\u202f+\u20093) in 88.4%. The reported complication rate was 7.3%, with subarachnoid hemorrhage as the most frequent complication (3.4%), followed by parenchymal hemorrhage (1.7%) and embolization in new territories (1.2%). Overall, the median time interval from symptom onset to hospital admission was 94\u202fmin (quartiles 59/180\u202fmin), the median time from hospital admission to groin puncture was 74\u202fmin (lower/upper quartile 47/103\u202fmin), and the median duration of the procedure 43\u202fmin (lower/upper quartile 25.2/73.2\xa0min). A\xa0comparison between primary and secondary referral revealed a\xa0significant faster symptom-to-intervention time for primary referrals, whereas in-house workflows showed no significant difference. Conclusion The analysis represents the largest documented cohort of acute stroke patients treated by thrombectomy. The documentation allows for a\xa0detailed evaluation of procedural, clinical, logistic and radiation exposure data and might be used for monitoring the quality of the treatment on a\xa0nationwide scale.