CURRENT TRENDS IN REPERFUSION THERAPY FOR ACUTE ISCHEMIC STROKE: ANALYSIS FROM A NATIONWIDE MUTICENTER REGISTER

초록

Background and Aims: Reperfusion therapy is the most effective treatment for acute ischemic stroke (AIS). We aimed to analyze the changes in reperfusion therapy in real-world practice over the past 10 years when the advances in techniques of endovascular therapy (EVT) and expansion of therapeutic time window have been established. Methods: Using data from the Clinical Research Center for Stroke-Korea, a nationwide multicenter stroke register, we analyzed trends in intravenous thrombolysis (IVT) and EVT between 2011 and 2020. Time trends were assessed for rates of IVT, EVT, door to needle (DTN) time, and door to puncture (DTP) time. Trends were analyzed with adjusting for age, sex, initial stroke severity using generalized linear mixed model with random effect for center. Results: Among 70,450 AIS patients enrolled 17 participating centers, patients receiving reperfusion therapy increased from 14.7% in 2011 to 17.5% in 2020 (P<0.001). During the study period, EVT rate almost doubled from 5.4% in 2011 to 10.6% in 2020. However, IVT rate increased from 12.9% in 2011 to 15.5% in 2014 and then decreased to 10.9% in 2020. Among IVT cases, the proportions of DTN time either ⩽60 min or ⩽45 min has not changed over time, whereas that of DTP time ⩽60 min among EVT cases has increased. Conclusions: In a large multicenter register, we observed a significant increase in the reperfusion therapy rate with a marked increase in EVT for the treatment of AIS over the past 10 years, but IVT rate showed a decreasing trend from the mid-2010s.