2 research outputs found
Aspiration Versus StentâRetriever as FirstâLine Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A PropensityâScore Matched Multicenter Analysis
Background For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stentâretriever for firstâline reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to firstâline technique in a large, multicenter registry. Methods Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to firstâline endovascular technique (stentâretriever versus aspiration). Multivariable logistic regression and propensityâscore matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2bâ3 (âsuccessful recanalizationâ), as well as secondary outcomes (firstâpass effect, expanded Thrombolysis in Cerebral Infarction 2câ3, intracerebral hemorrhage, and 90âday modified Rankin scale, 90âday mortality) between treatment groups. Results Of the 440 included patients (44.5% stentâretriever versus 55.5% aspiration), those treated with stentâretriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9; P<0.01), higher National Institutes of Health Stroke Scale scores (median 13 versus 11; P=0.02), and nonsignificantly fewer mediumâdistal occlusions (M3, A2, P2, or other: 17.4% versus 23.8%; P=0.10). Use of a stentâretriever was associated with 15% lower odds of successful recanalization (odds ratio [OR], 0.85; [95% CI 0.74â0.98]; P=0.02), but this was not significant after multivariable adjustment in the total cohort (adjusted OR, 0.88; [95% CI 0.72â1.09]; P=0.24), or in the propensityâscore matched cohort (n=105 in each group) (adjusted OR, 0.94; [95% CI 0.75â1.18]; P=0.60). There was no significant association between technique and secondary outcomes in the propensityâscore matched adjusted models. Conclusion In this large, diverse, multinational medium vessel occlusion cohort, we found no significant difference in imaging or clinical outcomes with aspiration versus stentâretriever thrombectomy
The histology of brain tumors for 67 331 children and 671 085 adults diagnosed in 60 countries during 2000-2014: a global, population-based study (CONCORD-3)
Auteurs : The CONCORD Working GroupInternational audienceBackground: Global variations in survival for brain tumors are very wide when all histological types are considered together. Appraisal of international differences should be informed by the distribution of histology, but little is known beyond Europe and North America.Methods: The source for the analysis was the CONCORD database, a program of global surveillance of cancer survival trends, which includes the tumor records of individual patients from more than 300 population-based cancer registries. We considered all patients aged 0-99 years who were diagnosed with a primary brain tumor during 2000-2014, whether malignant or nonmalignant. We presented the histology distribution of these tumors, for patients diagnosed during 2000-2004, 2005-2009, and 2010-2014.Results: Records were submitted from 60 countries on 5 continents, 67 331 for children and 671 085 for adults. After exclusion of irrelevant morphology codes, the final study population comprised 60 783 children and 602 112 adults. Only 59 of 60 countries covered in CONCORD-3 were included because none of the Mexican records were eligible. We defined 12 histology groups for children, and 11 for adults. In children (0-14 years), the proportion of low-grade astrocytomas ranged between 6% and 50%. Medulloblastoma was the most common subtype in countries where low-grade astrocytoma was less commonly reported. In adults (15-99 years), the proportion of glioblastomas varied between 9% and 69%. International comparisons were made difficult by wide differences in the proportion of tumors with unspecified histology, which accounted for up to 52% of diagnoses in children and up to 65% in adults.Conclusions: To our knowledge, this is the first account of the global histology distribution of brain tumors, in children and adults. Our findings provide insights into the practices and the quality of cancer registration worldwide