Mechanical Thrombectomy in and Outside the REVASCAT Trial
Authors: Urra Xabier , Abilleira Sònia , Dorado Laura , Ribó Marc , Cardona Pere , Millán Mònica , Chamorro Angel , Molina Carlos , Cobo Erik , Dávalos Antoni , Jovin Tudor G. , Gallofré Miquel ,   Catalan Stroke Code and Reperfusion Consortium Stroke Program:, Martí Fàbregas Joan , Delgado Mederos Raquel , Martínez Domeño Alejandro , Marín Bueno Rebeca , Roquer Jaume , Rodríguez-Campello Ana , Ois Ángel , Cuadrado-Godia Elisa , Giralt Eva , Vivas Elio , Guimaraens Leopoldo , Obach Víctor , Amaro Sergio , Macho Juan M. , Blasco Jordi , San Roman Manzanera Luis , López Antonio , Martínez-Yélamos Antonio , Quesada Helena , Cano Lluis , Aja Lucia , de Miquel Maria Angeles , Mora Paloma , Molina Carlos , Rubiera Marta , Pagola Jorge , Santamarina Esteban , Álvarez-Sabín José , Tomasello Alejandro , Coscojuela Pilar , Pérez de la Ossa Natalia , Gomis Meritxell , López-Cancio Elena , Castaño Carlos , Cánovas David , del Carmen Garcia Maria , Estela Jordi , Perendreu Joan , Krupinski Jerzy , Huertas Folch Sonia , Herrerias M. Carme Nicolás , Gómez-Choco Manuel , García Sonia , Martínez Raul , Purroy Francisco , Sanahuja Jordi , Serena Joaquín , Castellanos Mar , Silva Yolanda , van Eendenburg Cecile , Marés Rafael , Pellisé Anna , Ustrell Xavier , Baiges Juanjo , Garcés Moisés , Saura Júlia , Soler Insa Josep Maria , Aragonés Josep Maria , Cocho Calderón Lola , Otermin Vallejo Pilar , Palomeras Ernest 
Published: October 2015

Background and Purpose—
Recent trials have shown the superiority of endovascular thrombectomy (EVT) over medical therapy alone in certain stroke patients with proximal arterial occlusion. Using data from the Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke due to Anterior Circulation Large Vessel Occlusion Presenting Within 8-Hours of Symptom Onset (REVASCAT) and a parallel reperfusion treatment registry, we sought to assess the utilization of EVT in a defined patient population, comparing the outcomes of patients treated in and outside the REVASCAT trial.

Methods—
SONIIA [Sistema Online d’Informació de l’Ictus Agut], a population-based, government-mandated, prospective registry of reperfusion therapies for stroke encompassing the entire population of Catalonia, was used as data source. The registry documents 5 key inclusion criteria of the REVASCAT trial: age, stroke severity, time to treatment, baseline functional status, and occlusion site. We compared procedural, safety, and functional outcomes in patients treated inside and outside the trial.

Results—
From November 2012 to December 2014, out of 17596 ischemic stroke patients in Catalonia (population 7.5 million), 2576 patients received reperfusion therapies (17/100000 inhabitants-year), mainly intravenous thrombolysis only (2036). From the remaining 540 treated with EVT, 103 patients (out of 206 randomized) were treated within REVASCAT and 437 outside the trial. Of these, 399 did not fulfill some of the study criteria, and 38 were trial candidates (8 treated at REVASCAT centers and 30 at 2 non-REVASCAT centers). The majority of procedural, safety, and functional outcomes were similar in patients treated with EVT within and outside REVASCAT.

Conclusions—
REVASCAT enrolled nearly all eligible patients representing one third of all patients treated with EVT. Patients treated with EVT within and outside REVASCAT had similar outcomes, reinforcing the therapeutic value of EVT.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01692379.