Path From Clinical Research to Implementation

• DOI: 10.1161/strokeaha.119.026731
• Publication Date: 2020-06-17T13:27:37Z
• Authors: Eveline J.A. Wiegers; Kars C.J. Compagne; Paula M. Janssen; Esmee Venema; Jaap W. Deckers; Wouter J. Schonew...; Jan Albert Vos; Geert J. Lycklama...; Bob Roozenbeek; Jasper M. Martens; Jeannette Hofmeijer; Robert-Jan van Oo...; Wim H. van Zwam; Charles B.L.M. Ma...; Aad van der Lugt; H.F. Lingsma; Yvo B.W.E.M. Roos; Diederik W.J. Dippel; Jelis Boiten; Josje Brouwer; Sanne J. den Hartog; Wouter H. Hinsenveld; Manon Kappelhof; Robert-Jan B. Gol...; Maxim J.H.L. Mulder; Ivo G.H. Jansen; Adriaan C.G.M. va...; Bart J. Emmer; Jonathan M. Coutinho; Marieke J.H. Wermer; Marianne A.A. van...; Julie Staals; Jelis Boiten; Sebastiaan F. de ...; Lukas C. van Dijk; H. Bart van der Worp; Rob H. Lo; Ewoud J. van Dijk; Hieronymus D. Boo...; J. de Vries; Paul L.M. de Kort; Julia van Tuijl; Jo Jo P. Peluso; Puck Fransen; Jan S.P. van den ...; Boudewijn A.A.M. ...; Leo A.M. Aerden; René J. Dallinga; Maarten Uyttenboo...; Omid Eschgi; Reinoud P.H. Bokkers; Tobien H.C.M.L. S...; Roel J.J. Heijboer; Koos Keizer; Lonneke S.F. Yo; Heleen M. den Hertog; Emiel J.C. Sturm; Paul Brouwers; Marianne A.A. van...; Marieke E.S. Spre...; Sjoerd F.M. Jenni...; René van den Berg; Albert J. Yoo; Ludo F.M. Beenen; Alida A. Postma; Stefan D. Roosendaal; Bas F.W. van der ...; Ido R. van den Wi...; Adriaan C.G.M. va...; Bart J. Emmer; Lonneke S.F. Yo; Joost Bot; Pieter-Jan van Do...; Anton Meijer; Elyas Ghariq; Reinoud P.H. Bokkers; Marc P. van Proosdij; G. Menno Krieteme...; Jo P. Peluso; Hieronymus D. Boo...; Rob Lo; Dick Gerrits; Wouter Dinkelaar; Auke P.A. Appelman; Bas Hammer; Sjoert Pegge; Anouk van der Hoorn; Saman Vinke; Jelis Boiten; H. Bart van der Worp; Rob H. Lo; H. Zwenneke Flach; Naziha el Ghannouti; Martin Sterrenberg; Corina Puppels; Wilma Pellikaan; Rita Sprengers; Marjan Elfrink; Michelle Simons; Marjolein Vossers; Joke de Meris; Tamara Vermeulen; Annet Geerlings; Gina van Vemde; Tiny Simons; Cathelijn van Rij...; Gert Messchendorp; Nynke Nicolaij; Hester Bongenaar; Karin Bodde; Sandra Kleijn; Jasmijn Lodico; Hanneke Droste; Maureen Wollaert; Sabrina Verheesen; D. Jeurrissen; Erna Bos; Yvonne Drabbe; Michelle Sandiman; Marjan Elfrink; Nicoline Aaldering; Berber Zweedijk; Mostafa Khalilzada; Jocova Vervoort; Hanneke Droste; Nynke Nicolaij; Michelle Simons; Eva Ponjee; Sharon Romviel; Karin Kanselaar; Erna Bos; Denn Barning; Vicky Chalos; Ralph R. Geuskens; Tim van Straaten; Saliha Ergezen; Roger R.M. Harmsma; Daan Muijres; Anouk de Jong; Olvert A. Berkhemer; Anna M.M. Boers; J. Huguet; P.F.C. Groot; Marieke A. Mens; Katinka R. van Kr...; Kilian M. Treurniet; Ivo G.H. Jansen; Manon L. Tolhuisen; Heitor Alves; Annick J. Weterings; Eleonora L.F. Kir...; Eva J.H.F. Voogd; Lieve M. Schupp; Sabine Collette; Adrien E.D. Groot; Natalie E. LeCouffe; Praneeta R. Konduri; Haryadi Prasetya; Nerea Arrarte-Ter...; Lucas A. Ramos
• Keywords: SELECTION; Male; EMC NIHES-02-65-01; ischemia; THERAPY; Brain Ischemia; NUMBER; 03 medical and health sciences; 0302 clinical medicine; Medical Imaging - Radboud University Medical Center; Humans; Registries; Aged; Netherlands; Aged, 80 and over; implementation science; MECHANICAL THROMBECTOMY; Patient Selection; Endovascular Procedures; 22/2 OA procedure; Radboudumc 3: Disorders of movement DCMN: Donders Center for Medical Neuroscience; Radboudumc 9: Rare cancers RIHS: Radboud Institute for Health Sciences; Middle Aged; stroke; brain ischemia; EMC NIHES-03-30-02; 3. Good health; Stroke; INTRAVENOUS T-PA; Treatment Outcome; thrombectomy; ONSET; TRIAL; Female; Radboudumc 0: Other Research RIHS: Radboud Institute for Health Sciences; EMC COEUR-09

Before 2015, endovascular treatment (EVT) for acute ischemic stroke was considered a promising treatment option. Based on limited evidence, it was performed in several dedicated stroke centers worldwide on selected patients. Since 2015, EVT for patients with intracranial large vessel occlusion has quickly been implemented as standard treatment in many countries worldwide, supported by the revised international guidelines based on solid evidence from multiple clinical trials. We describe the development in use of EVT in the Netherlands before, during, and after the pivotal EVT trials. We used data from all patients who were treated with EVT in the Netherlands from January 2002 until December 2018. We undertook a time-series analysis to examine trends in the use of EVT using Poisson regression analysis. Incidence rate ratios per year with 95% CIs were obtained to demonstrate the impact and implementation after the publication of the EVT trial results. We made regional observation plots, adjusted for stroke incidence, to assess the availability and use of the treatment in the country. In the buildup to the MR CLEAN (Multicenter Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands), a slow increase of EVT patients was observed, with 0.2% of all ischemic stroke patients receiving EVT. Before the trial results were formally announced, a statistically significant increase in EVT-treated patients per year was observed (incidence rate ratio, 1.72 [95% CI, 1.46–2.04]), and after the trial publication, an immediate steep increase was seen, followed by a more gradual increase (incidence rate ratio, 2.14 [95% CI, 1.77–2.59]). In 2018, the percentage of ischemic stroke patients receiving EVT increased to 5.8%. A well-developed infrastructure, a pragmatic approach toward the use of EVT in clinical practice, in combination with a strict adherence by the regulatory authorities to national evidence-based guidelines has led to successful implementation of EVT in the Netherlands. Ongoing efforts are directed at further increasing the proportion of stroke patients with EVT in all regions of the country.