Evaluation of Functional Recovery of Patients With Acute Ischemic Stroke Treated by Thrombectomy (EPIC)
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About
The management of cerebral infarctions (CI) is a real public health issue. The French National Authority for Health recommends Mechanical Thrombectomy (MT) either in combination with Intravenous Thrombolysis (IVT), or alone, after failure of IVT or in case of contraindication to IVT, within 6 hours of the onset of symptoms.
The objective is to determine the factors predicting good functional recovery at 3 months in order to establish the typical profile of the "good responder" patient to MT and to evaluate functional recovery at 3 and 12 months (mRS ≤ 2) according to the modality of MT (depending on whether it is performed during the day or at night), the age of the patients, the equipment used for MT, the type of anaesthesia, as well as the impact of the metrics from the radiological evaluation in the patient's management. patient management.
Full description
The management of cerebral infarction (CI) is a real public health issue. There are 120,000 hospitalizations of CI patients per year in France. It is the leading cause of acquired disability and the second leading cause of dementia. Since 2015, the scientific community has demonstrated the benefits of mechanical thrombectomy (MT) in the treatment of patients with CI. The French National Authority for Health (HAS) recommends MT either in combination with intravenous (IV) thrombolysis, or alone, after failure of IV thrombolysis or in case of contraindication to IV thrombolysis, within 6 hours of the onset of symptoms.
Based on previous studies, the HAS has extended its recommendations for the treatment of patients (with occlusion of large vessels of the anterior cerebral circulation) whose onset of symptoms or last seen asymptomatic is between 6 and 16 hours, and may even extend up to 24 hours depending on strict inclusion criteria.
These previous clinical trials have shown the remarkable efficacy of MT in CI patients under the age of 80. There are no clear recommendations for MT in patients over 80 years of age, and further research is needed to improve the safety of MT.
Further research is needed to improve patient selection in the elderly. Today, predictive factors impacting on functional recovery such as age, blood glucose, and NIHSS neurological severity score have been evaluated. However, no association between these factors during the course of treatment has been established to determine the clinical and radiological characteristics that define the standard profile of "good responders" to MT.
The cohort is a continuation of the data previously collected in a database of the Commission Nationale de l'Informatique et des Libertés (CNIL). This database reports a complete follow-up (clinical, imaging and MT procedure data) of patients, from admission to 3 months after their hospitalisation. Some results have already been published.
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Inclusion criteria
- Age ≥ 18 years
- Indication for treatment with Mechanical Thrombectomy
- Imaging on admission (Scanner and/or Magnetic Resonance Imaging (MRI)) showing occlusion of a large intracranial artery intracranial artery (anterior, middle, posterior cerebral artery, basilar artery, vertebral vertebral artery)
- Health insurance coverage
- Obtaining the patient's consent
Exclusion criteria
- Patient with a serious intercurrent pathology impacting the vital prognosis in the short term and making it impossible to follow up at 3 months.
- Patients for whom follow-up will be impossible (foreign tourists)
- Patients of legal age (under guardianship, under curatorship, deprived of liberty)
Trial design
540 participants in 1 patient group
Trial contacts and locations
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Central trial contact
Cyril Dargazanli
Data sourced from clinicaltrials.gov
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