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.

中文翻译：

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从临床研究到实施的道路：荷兰缺血性卒中的血管内治疗。

在2015年之前，急性缺血性卒中的血管内治疗（EVT）被认为是一种有前途的治疗选择。基于有限的证据，它是在全球范围内的一些专门针对中风患者的中风中心进行的。自2015年以来，基于经过多次临床试验的确凿证据，修订后的国际指南在全球许多国家中迅速将颅内大血管闭塞患者的EVT用作标准治疗。我们描述了在关键的EVT试验之前，期间和之后，荷兰EVT使用的发展。我们使用了2002年1月至2018年12月在荷兰接受EVT治疗的所有患者的数据。我们进行了时间序列分析，以通过Poisson回归分析检查EVT的使用趋势。获得了具有95％CI的每年发生率比率，以证明EVT试验结果发布后的影响和实施。我们绘制了针对卒中发生率进行调整的区域观察图，以评估该国治疗的可用性和使用情况。在MR CLEAN（荷兰急性缺血性卒中的血管内治疗多中心临床试验）的基础上，观察到EVT患者缓慢增加，所有缺血性卒中患者中有0.2％接受了EVT。在正式宣布试验结果之前，观察到经EVT治疗的患者每年都有统计学上的显着增加（发生率比，1.72 [95％CI，1.46–2.04]），并且在试验发表后，立即看到急剧增加。 ，然后逐渐增加（发生率，2.14 [95％CI，1.77–2.59]）。在2018年，接受EVT的缺血性中风患者的比例增加到5.8％。发达的基础设施，在临床实践中使用EVT的务实方法以及监管机构严格遵守国家循证指南的要求，导致在荷兰成功实施EVT。正在进行的努力旨在进一步增加该国所有地区的EVT中风患者的比例。