TY - JOUR
T1 - Path From Clinical Research to Implementation Endovascular Treatment of Ischemic Stroke in the Netherlands
AU - Wiegers, Eveline J. A.
AU - Compagne, Kars C. J.
AU - Janssen, Paula M.
AU - Venema, Esmee
AU - Deckers, Jaap W.
AU - Schonewille, Wouter J.
AU - Albert Vos, Jan
AU - Nijeholt, Geert J. Lycklama A.
AU - Roozenbeek, Bob
AU - Martens, Jasper M.
AU - Hofmeijer, Jeannette
AU - van Oostenbrugge, Robert-Jan
AU - van Zwam, Wim H.
AU - Majoie, Charles B. L. M.
AU - van der Lugt, Aad
AU - Lingsma, H. F.
AU - Roos, Yvo B. W. E. M.
AU - Dippel, Diederik W. J.
AU - MR CLEAN Registry Collaborators
PY - 2020/7
Y1 - 2020/7
N2 - Before 2015, endovascular treatment (EVT) for acute ischemic stroke was considered a promising treatment option. Based on limited evidence, it was performed in several dedicated stroke centers worldwide on selected patients. Since 2015, EVT for patients with intracranial large vessel occlusion has quickly been implemented as standard treatment in many countries worldwide, supported by the revised international guidelines based on solid evidence from multiple clinical trials. We describe the development in use of EVT in the Netherlands before, during, and after the pivotal EVT trials. We used data from all patients who were treated with EVT in the Netherlands from January 2002 until December 2018. We undertook a time-series analysis to examine trends in the use of EVT using Poisson regression analysis. Incidence rate ratios per year with 95% CIs were obtained to demonstrate the impact and implementation after the publication of the EVT trial results. We made regional observation plots, adjusted for stroke incidence, to assess the availability and use of the treatment in the country. In the buildup to the MR CLEAN (Multicenter Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands), a slow increase of EVT patients was observed, with 0.2% of all ischemic stroke patients receiving EVT. Before the trial results were formally announced, a statistically significant increase in EVT-treated patients per year was observed (incidence rate ratio, 1.72 [95% CI, 1.46-2.04]), and after the trial publication, an immediate steep increase was seen, followed by a more gradual increase (incidence rate ratio, 2.14 [95% CI, 1.77-2.59]). In 2018, the percentage of ischemic stroke patients receiving EVT increased to 5.8%. A well-developed infrastructure, a pragmatic approach toward the use of EVT in clinical practice, in combination with a strict adherence by the regulatory authorities to national evidence-based guidelines has led to successful implementation of EVT in the Netherlands. Ongoing efforts are directed at further increasing the proportion of stroke patients with EVT in all regions of the country.
AB - Before 2015, endovascular treatment (EVT) for acute ischemic stroke was considered a promising treatment option. Based on limited evidence, it was performed in several dedicated stroke centers worldwide on selected patients. Since 2015, EVT for patients with intracranial large vessel occlusion has quickly been implemented as standard treatment in many countries worldwide, supported by the revised international guidelines based on solid evidence from multiple clinical trials. We describe the development in use of EVT in the Netherlands before, during, and after the pivotal EVT trials. We used data from all patients who were treated with EVT in the Netherlands from January 2002 until December 2018. We undertook a time-series analysis to examine trends in the use of EVT using Poisson regression analysis. Incidence rate ratios per year with 95% CIs were obtained to demonstrate the impact and implementation after the publication of the EVT trial results. We made regional observation plots, adjusted for stroke incidence, to assess the availability and use of the treatment in the country. In the buildup to the MR CLEAN (Multicenter Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands), a slow increase of EVT patients was observed, with 0.2% of all ischemic stroke patients receiving EVT. Before the trial results were formally announced, a statistically significant increase in EVT-treated patients per year was observed (incidence rate ratio, 1.72 [95% CI, 1.46-2.04]), and after the trial publication, an immediate steep increase was seen, followed by a more gradual increase (incidence rate ratio, 2.14 [95% CI, 1.77-2.59]). In 2018, the percentage of ischemic stroke patients receiving EVT increased to 5.8%. A well-developed infrastructure, a pragmatic approach toward the use of EVT in clinical practice, in combination with a strict adherence by the regulatory authorities to national evidence-based guidelines has led to successful implementation of EVT in the Netherlands. Ongoing efforts are directed at further increasing the proportion of stroke patients with EVT in all regions of the country.
KW - brain ischemia
KW - ischemia
KW - implementation science
KW - stroke
KW - thrombectomy
KW - INTRAVENOUS T-PA
KW - MECHANICAL THROMBECTOMY
KW - THERAPY
KW - SELECTION
KW - NUMBER
KW - TRIAL
KW - ONSET
U2 - 10.1161/STROKEAHA.119.026731
DO - 10.1161/STROKEAHA.119.026731
M3 - Article
C2 - 32568637
VL - 51
SP - 1941
EP - 1950
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 7
ER -