Limits...
Case characteristics, hyperacute treatment, and outcome information from the clinical research center for stroke-fifth division registry in South Korea.

Kim BJ, Park JM, Kang K, Lee SJ, Ko Y, Kim JG, Cha JK, Kim DH, Nah HW, Han MK, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Cho KH, Kim JT, Choi JC, Kim WJ, Shin DI, Yeo MJ, Sohn SI, Hong JH, Lee J, Lee JS, Yoon BW, Bae HJ - J Stroke (2015)

Bottom Line: The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases.Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes.The above findings will be compared with other Asian and US registry data in this article.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.

ABSTRACT
Characteristics of stroke cases, acute stroke care, and outcomes after stroke differ according to geographical and cultural background. To provide epidemiological and clinical data on stroke care in South Korea, we analyzed a prospective multicenter clinical stroke registry, the Clinical Research Center for Stroke-Fifth Division (CRCS-5). Patients were 58% male with a mean age of 67.2±12.9 years and median National Institutes of Health Stroke Scale score of 3 [1-8] points. Over the 6 years of operation, temporal trends were documented including increasing utilization of recanalization treatment with shorter onset-to-arrival delay and decremental length of stay. Acute recanalization treatment was performed in 12.7% of cases with endovascular treatment utilized in 36%, but the proportion of endovascular recanalization varied across centers. Door-to-IV alteplase delay had a median of 45 [33-68] min. The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases. Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes. The proportion of mRS scores of 0-1 was 42% on discharge, 50% at 3 months, and 55% at 1 year after the index stroke. Recurrent stroke up to 1 year occurred in 4.5% of patients; the rate was higher among older individuals and those with neurologically severe deficits. The above findings will be compared with other Asian and US registry data in this article.

No MeSH data available.


Related in: MedlinePlus

Hospital variability in hyperacute treatment modality.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4325643&req=5

Figure 4: Hospital variability in hyperacute treatment modality.

Mentions: Endovascular recanalization treatment became widely available in clinical practice due to its intuitive outcomes and its function as a rescue treatment.21 Two separate phase II clinical trials in 2,012 reported superior efficacy of newer thrombectomy stent devices, and thus supported wider acceptance of endovascular modalities.22,23,24 Among the 2,724 recanalization-treated cases in the CRCS-5 registry, endovascular treatment with or without preceding IV alteplase was utilized in 38% of cases (Table 4). Combined IV-endovascular recanalization treatment was usually performed for cases arriving within the time window of IV thrombolysis and for those who had higher prevalence of atrial fibrillation, higher NIHSS scores, and lower pre-stroke disability. The arrival-to-initiation of IV alteplase injection was comparable between IV alteplase-only and combined IV and endovascular treatment groups. Between endovascular-only and combined treatment groups, preceding IV alteplase did not cause a significant delay in the intrahospital logistics of stroke cases. Interestingly, a lower dose of IV alteplase (0.6 mg/kg) was utilized in 29% (653) of the 2,724 cases, but the proportion was much higher in the combined IV and endovascular groups at 55% (P-for difference <0.01). In the current descriptive analyses, the combined IV and endovascular treatment group showed a larger degree of NIHSS score decrement over the first 24 hours following treatment, but the prevalence of hemorrhagic transformation was elevated. Mortality rate at discharge and at 3 months after stroke was comparable between the IV-only and endovascular-treated groups, but the proportion of mRS scores of 0-1 was lower in the endovascular group. Although the efficacy of endovascular recanalization was suggested in the prior phase II trials, the scientific evidence supporting the treatment modality is still lacking, as demonstrated in phase III trials with older-generation modalities.25,26,27 Such confusion is prevalent among CRCS-5 registry centers (Figure 4). The real-world effectiveness of hyperacute endovascular intervention warrants further investigation, and the clinical registry with disparity between centers on this issue would be a valuable source for clinical analyses.


Case characteristics, hyperacute treatment, and outcome information from the clinical research center for stroke-fifth division registry in South Korea.

Kim BJ, Park JM, Kang K, Lee SJ, Ko Y, Kim JG, Cha JK, Kim DH, Nah HW, Han MK, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Cho KH, Kim JT, Choi JC, Kim WJ, Shin DI, Yeo MJ, Sohn SI, Hong JH, Lee J, Lee JS, Yoon BW, Bae HJ - J Stroke (2015)

Hospital variability in hyperacute treatment modality.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325643&req=5

Figure 4: Hospital variability in hyperacute treatment modality.
Mentions: Endovascular recanalization treatment became widely available in clinical practice due to its intuitive outcomes and its function as a rescue treatment.21 Two separate phase II clinical trials in 2,012 reported superior efficacy of newer thrombectomy stent devices, and thus supported wider acceptance of endovascular modalities.22,23,24 Among the 2,724 recanalization-treated cases in the CRCS-5 registry, endovascular treatment with or without preceding IV alteplase was utilized in 38% of cases (Table 4). Combined IV-endovascular recanalization treatment was usually performed for cases arriving within the time window of IV thrombolysis and for those who had higher prevalence of atrial fibrillation, higher NIHSS scores, and lower pre-stroke disability. The arrival-to-initiation of IV alteplase injection was comparable between IV alteplase-only and combined IV and endovascular treatment groups. Between endovascular-only and combined treatment groups, preceding IV alteplase did not cause a significant delay in the intrahospital logistics of stroke cases. Interestingly, a lower dose of IV alteplase (0.6 mg/kg) was utilized in 29% (653) of the 2,724 cases, but the proportion was much higher in the combined IV and endovascular groups at 55% (P-for difference <0.01). In the current descriptive analyses, the combined IV and endovascular treatment group showed a larger degree of NIHSS score decrement over the first 24 hours following treatment, but the prevalence of hemorrhagic transformation was elevated. Mortality rate at discharge and at 3 months after stroke was comparable between the IV-only and endovascular-treated groups, but the proportion of mRS scores of 0-1 was lower in the endovascular group. Although the efficacy of endovascular recanalization was suggested in the prior phase II trials, the scientific evidence supporting the treatment modality is still lacking, as demonstrated in phase III trials with older-generation modalities.25,26,27 Such confusion is prevalent among CRCS-5 registry centers (Figure 4). The real-world effectiveness of hyperacute endovascular intervention warrants further investigation, and the clinical registry with disparity between centers on this issue would be a valuable source for clinical analyses.

Bottom Line: The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases.Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes.The above findings will be compared with other Asian and US registry data in this article.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.

ABSTRACT
Characteristics of stroke cases, acute stroke care, and outcomes after stroke differ according to geographical and cultural background. To provide epidemiological and clinical data on stroke care in South Korea, we analyzed a prospective multicenter clinical stroke registry, the Clinical Research Center for Stroke-Fifth Division (CRCS-5). Patients were 58% male with a mean age of 67.2±12.9 years and median National Institutes of Health Stroke Scale score of 3 [1-8] points. Over the 6 years of operation, temporal trends were documented including increasing utilization of recanalization treatment with shorter onset-to-arrival delay and decremental length of stay. Acute recanalization treatment was performed in 12.7% of cases with endovascular treatment utilized in 36%, but the proportion of endovascular recanalization varied across centers. Door-to-IV alteplase delay had a median of 45 [33-68] min. The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases. Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes. The proportion of mRS scores of 0-1 was 42% on discharge, 50% at 3 months, and 55% at 1 year after the index stroke. Recurrent stroke up to 1 year occurred in 4.5% of patients; the rate was higher among older individuals and those with neurologically severe deficits. The above findings will be compared with other Asian and US registry data in this article.

No MeSH data available.


Related in: MedlinePlus