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The impact of large core and late treatment trials: An update on the modelled annual thrombectomy eligibility of UK stroke patients

Lookup NU author(s): Dr Peter McMeekin, Dr Christopher Price, Professor Phil White

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© European Stroke Organisation 2024.Introduction: To support decisions about thrombectomy provision, we have previously estimated the annual UK population eligible for treatment as ∼10% of stroke admissions. Since then, eight further randomised trials that could alter the eligibility rate have reported in 2021-23. We updated our estimates of the eligible population from these trials and other recent studies. Patients and methods: An updated decision tree describing the EVT eligible population for UK stroke admissions was produced. Decision criteria were derived from the highest level of evidence available. For nodes where no specific RCT data existed, evidence was obtained from the latest systematic review(s) or the highest quality observational data. Results: We estimate that 15,420 (approximately 15%) of admitted UK stroke patients are now eligible for thrombectomy, or 14,930 if advanced brain imaging using MRI/CT perfusion or collateral assessment were used in all patients. This is a 54% increase in our previous estimate in 2021. Over 50% of LAO strokes are now potentially eligible for thrombectomy. The increase in eligibility is principally due to a much larger cohort of later presenting and/or larger ischaemic core patients. Conclusion: Most previously independent LAO stroke patients presenting within 24 h, even in the presence of a large ischaemic core on initial non-contrast CT, should be considered for thrombectomy with use of advanced brain imaging in those presenting beyond 12 h to identify salvageable penumbral brain tissue. Treatment in most patients remains critically time-dependent and our estimates should be interpreted with this in mind.

Publication metadata

Author(s): McMeekin P, James M, Price CI, Ford GA, White P

Publication type: Article

Publication status: Published

Journal: European Stroke Journal

Year: 2024

Pages: epub ahead of print

Online publication date: 17/02/2024

Acceptance date: 29/02/2024

Date deposited: 04/03/2024

ISSN (print): 2396-9873

ISSN (electronic): 2396-9881

Publisher: Sage Publications Ltd

URL: https://doi.org/10.1177/23969873241232820

DOI: 10.1177/23969873241232820

PubMed id: 38366958

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