Introduction: Mechanical thrombectomy (MT) is the standard of care for patients with large vessel occlusions supported by evidence from 5 multicenter randomized clinical trials. MT is technically nuanced. Little has been published on the learning curve for this technique. In this study we sought to explore evidence for a learning curve in the management of large vessel occlusions at a high-volume regional stroke center.
Methods: Patients who were considered for MT treatment at Yale-New Haven Hospital between January 2015 and November 2017 were included. Of 267 patients considered for thrombectomy, 48 patients were excluded because an MT was not performed, leaving 219 patients for analysis. These included patients with M1, M2, distal MCA, supraclinoid ICA (or T-), anterior circulation tandem, and vertebrobasilar occlusions. Baseline characteristics, procedural variables, and functional outcome were collected.
Results: There were no significant differences over time in baseline characteristics, comorbidities, and antiplatelet / anticoagulant use. There was significant improvement overtime in post-procedural NIHSS (14+/-9 in 2015; 15+/-10 in 2016; 10+/-9 in 2017; P = 0.003) and rates of good functional outcome (mRS 0-2) at 90 days (20% in 2015; 25% in 2016; 40% in 2017; P = 0.03). Note was made of significantly fewer symptomatic reperfusion hemorrhages and death at 3 months overtime. There was a trend toward improved revascularization (TICI 2b-3) overtime (69% in 2015; 68% in 2016; 82% in 2017; P = 0.058).
Conclusions: Better clinical outcomes were observed overtime in patients undergoing MT for large vessel occlusions. These better outcomes were accompanied by significantly fewer symptomatic reperfusion hemorrhages and less death at 3 months overtime. There was also a trend toward improved revascularization. These data support a learning curve for mechanical thrombectomy in large vessel occlusions and have important implications for the triage of these stroke patients in health systems and across regions.
Patient Care: This research provides evidence for a learning curve in the use of mechanical thrombectomy for large vessel occlusions. It has implications for the triage of stroke patients in health systems and across regions.
Learning Objectives: To better appreciate evidence for a learning curve in mechanical thrombectomy for large vessel occlusions