Neurointervention.  2018 Sep;13(2):84-89. 10.5469/neuroint.2018.01053.

Endovascular Treatment in Acute Ischemic Stroke: A Nationwide Survey in Korea

• Seo KD
• Suh SH

• KMID: 2424056
• DOI: http://doi.org/10.5469/neuroint.2018.01053

Abstract

PURPOSE
As endovascular therapy (EVT) has been approved as a treatment guideline for acute ischemic stroke (AIS), it has been increasing in Korea. We conducted a nationwide survey to evaluate the current status of EVT for patients with AIS in Korea.
MATERIALS AND METHODS
An electronic survey was sent to a representative clinician at each hospital where EVT was available in Korea. A Google survey was used to distribute the questionnaires and receive responses from October 2017 to December 2017.
RESULTS
Among 120 hospitals in our society, 76 participated in this survey. In 26% of the hospitals, more than 50 annual cases of EVT were performed, and 25-50 annual cases in 37%. Fifty-six hospitals (73.7%) achieved successful recanalization (thrombolysis in cerebral infarction ≥2b) in more than 80% of patients. Computed tomography (CT) angiography was the most common imaging modality for AIS treatment, and magnetic resonance (MR) diffusion, MR-perfusion/diffusion, and perfusion CT were frequently used in order. Non-eligibility criteria for EVT included a National Institutes of Health Stroke Scale < 4 (64.5%), the absence of MR perfusion/diffusion mismatch (52.6%), and a low Alberta Stroke Program Early CT Score (42.1%). For anterior circulation stroke, 60% of Korean hospitals adopted a wider time range of "8 hours" from symptom onset, while 70% of hospitals had a time limitation of 12-24 hours for posterior circulation stroke. The most preferred EVT device was a stentriever (89.4%). In the failed cases due to underlying stenosis, 79% of Korean hospitals performed angioplasty or stenting for revascularization.
CONCLUSION
This first nationwide survey showed that most Korean hospitals conducted EVT for AIS patients according to the present guideline in the era of mechanical thrombectomy by integrating the clinical experiences of many medical institutions and specialists.

Keyword

Ischemia; Stroke

MeSH Terms

Alberta
Angiography
Angioplasty
Cerebral Infarction
Constriction, Pathologic
Diffusion
Humans
Ischemia
Korea*
National Institutes of Health (U.S.)
Perfusion
Specialization
Stents
Stroke*
Thrombectomy

Figure

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  Fig. 1. Number of mechanical thrombectomy procedures per hospital in 2016 between tertiary and non-tertiary hospitals.

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  Fig. 2. Successful recanalization rate after mechanical thrombectomy at the responding hospitals.

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  Fig. 3. Time range after symptom onset for AIS treatment between anterior and posterior circulation. AIS, acute ischemic stroke.

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