Thrombectomy in acute ischemic stroke 2015 in Lund: a retrospective comparison of outcomes and assessment of times

Abstract: Background and purpose: Stroke is one of the world’s most common diseases and the second leading cause of death worldwide. From 1996 to 2006 the treatment of acute ischemic stroke (AIS) was limited to intravenous fibrinolytic therapy; a treatment often associated with risk and insufficiency. In 2006, treating AIS by mechanical clot removal, known as thrombectomy, was approved by the U.S. Food and Drug Administration (FDA). It did not garner much attention until 2015 when five major studies showed that outcomes dramatically improved. Today, thrombectomy is rapidly expanding and to ensure that it is correctly applied, quality must be continually evaluated. The primary purpose of this project is to evaluate thrombectomies performed in Lund between Jan 1, 2015 and Dec 31, 2015 by comparing patient outcomes with the corresponding data in the largest study. The secondary purpose is to summarise time intervals from ictus to thrombectomy as shorter times are always desirable. Methods: All data was collected from Picture and Archiving Communication Systems (PACS), Radiology Information System (RIS), and electronical medical charts. Patient outcomes were measured by autonomy according to the modified Rankin Scale (mRS) 90 days after thrombectomy and mortality. Results: mRS score was acquired for 49 of 74 patients of which 80 % were ≤ 2. Mortality was 18 %. The longest median interval was between first imaging and arrival to angio suite. The percentage of patients with mRS ≤ 2 was higher than the largest study compared, and if those with an unknown mRS would all be mRS ≥ 3, results would still be on par. Conclusion: It can thus be concluded that Lund in general has satisfactory outcomes. The interval between imaging and arrival to angio suite can be expected to be the longest, but it also holds the largest potential for improvement. As knowledge and experience of thrombectomy increases, more patients might successfully be treated.