A mono-centre observational study with the aim of compare clinical outcome at 3 month on patients admitted with recent cerebral infarct and intracranial large vessel occlusion in the anterior circulation who are eligible for mechanical thrombectomy in three different position : Patients admitted first in the Comprehensive Stroke Center of Montpellier, those transferred after Proximity Stroke Unit or prehospital bypass for patients with high suspicion of large vessel occlusion.to the Comprehensive Stroke Center of Montpellier
Multiple RCT has recently proved the superiority of mechanical thrombectomy compared to the best medical therapy (BMT) on patients with recent cerebral infarct and anterior circulation intracranial large vessel occlusion. In the Occitanie-Est region (ex Languedoc Roussillon), comprising 6 Stroke Unit, only the Comprehensive Stroke Unit of the CHU de Montpellier has a centre of interventional neuroradiology (NRI) that can perform mechanical thrombectomy. Patients suspected of stroke are referred to the nearest SU, then the candidates for thrombectomy, are transferred secondarily to the Stroke Center in Montpellier. Currently, there is no evidence that an initial management in a proximity stroke unit and a secondary transfer for a mechanical thrombectomy is associated with a loss of chance for patients, compared to patients initially treated at the Stroke Center regional reference. The objective of the study is to compare clinical outcome on patients admitted first in the Comprehensive Stroke Center of Montpellier those transferred after Proximity Stroke Unit or directly admitted when high suspicion of large vessel occlusion.
Study Type
OBSERVATIONAL
Enrollment
1,200
Neuroradiological endovascular treatment
Gui De Chauliac Hospital
Montpellier, France
RECRUITINGModified Rankin Score (mRS)
Good functional outcome ( defined by a Modified Rankin Scale of 0-2, 3 months after stroke onset Modified Rankin scale . Range 0 (asymptomatic) to 6 (death) * Good outcome : 0 to 2 * Disability : 3 to 5 * Bad outcome : 5 and 6
Time frame: 3 months
Incidence of mechanical thrombectomy treatment
Safety of medical complication Complications of mechanical thrombectomy : * Vessel perforation * Intramural Arterial dissection * Symptomatic Intracerebral hemorrhage * embolization to a new territory
Time frame: 24 hours
Clinical evolution at 24 hours
NIHSS scale and NIHSS scale variation between the inclusion at 24 hours National Institutes of Health Stroke Scale (NIHSS). Range 0-42. Neurological severity score at the acute phase : * Minor stroke : 0 to 5 * Moderate stroke 6 to 20 * Severe stroke up to 21
Time frame: 24 hours
Clinical evolution 7 days
NIHSS scale and NIHSS scale variation between the inclusion at 7 days National Institutes of Health Stroke Scale (NIHSS). Range 0-42. Neurological severity score at the acute phase : * Minor stroke : 0 to 5 * Moderate stroke 6 to 20 * Severe stroke up to 21
Time frame: 7 days
Proportion of patients having had mechanical trombectomy (and/or intravenous thrombolysis) amongst patient cohort.
Number of patients having had mechanical trombectomy (and/or intravenous thrombolysis) amongst patient cohort.
Time frame: 24 hours
Symptomatic Intracerebral Haemorrhage
symptomatic Intracerebral Haemorrhage on cerebral imaging at 24 hours
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Time frame: 24 hours
Arterial Recanalisation with TICI score
Quality of revascularization after mechanical thrombectomy : immediate post-Mechanical-Trombectomy evaluation for patient having had mechanical thrombectomy and at 24 hours for all patient cohort. TICI score (Thrombolysis In Cerebral Infarction grading system) describe the quality of revascularization after mechanical thrombectomy (Grade 0 for no perfusion at 3 for Complete perfusion)
Time frame: post-act / 24 hours