1.Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion
Isabel SIOW ; Benjamin Y.Q. TAN ; Keng Siang LEE ; Natalie ONG ; Emma TOH ; Anil GOPINATHAN ; Cunli YANG ; Pervinder BHOGAL ; Erika LAM ; Oliver SPOONER ; Lukas MEYER ; Jens FIEHLER ; Panagiotis PAPANAGIOTOU ; Andreas KASTRUP ; Maria ALEXANDROU ; Seraphine ZUBEL ; Qingyu WU ; Anastasios MPOTSARIS ; Volker MAUS ; Tommy ANDERSON ; Vamsi GONTU ; Fabian ARNBERG ; Tsong Hai LEE ; Bernard P.L. CHAN ; Raymond C.S. SEET ; Hock Luen TEOH ; Vijay K. SHARMA ; Leonard L.L. YEO
Journal of Stroke 2022;24(1):128-137
Background:
and Purpose Mechanical thrombectomy (MT) is an effective treatment for patients with basilar artery occlusion (BAO) acute ischemic stroke. It remains unclear whether bridging intravenous thrombolysis (IVT) prior to MT confers any benefit. This study compared the outcomes of acute BAO patients who were treated with direct MT versus combined IVT plus MT.
Methods:
This multicenter retrospective cohort study included patients who were treated for acute BAO from eight comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale 0–3 measured at 90 days. Secondary outcome measures included mortality and symptomatic intracranial hemorrhage (sICH).
Results:
Among 322 patients, 127 (39.4%) patients underwent bridging IVT followed by MT and 195 (60.6%) underwent direct MT. The mean±standard deviation age was 67.5±14.1 years, 64.0% were male and median National Institutes of Health Stroke Scale was 16 (interquartile range, 8 to 25). At 90-day, the rate of favorable functional outcome was similar between the bridging IVT and direct MT groups (39.4% vs. 34.4%, P=0.361). On multivariable analyses, bridging IVT was not asComorbidisociated with favorable functional outcome, mortality or sICH. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (37.2% vs. 15.5%, P=0.013).
Conclusions
Functional outcomes were similar in BAO patients treated with bridging IVT versus direct MT. In the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT may potentially confer benefit and this warrants further investigation.
2.Recanalization Therapies for Large Vessel Occlusion Due to Cervical Artery Dissection: A Cohort Study of the EVA-TRISP Collaboration
Christopher TRAENKA ; Johannes LORSCHEIDER ; Christian HAMETNER ; Philipp BAUMGARTNER ; Jan GRALLA ; Mauro MAGONI ; Nicolas MARTINEZ-MAJANDER ; Barbara CASOLLA ; Katharina FEIL ; Rosario PASCARELLA ; Panagiotis PAPANAGIOTOU ; Annika NORDANSTIG ; Visnja PADJEN ; Carlo W. CEREDA ; Marios PSYCHOGIOS ; Christian H. NOLTE ; Andrea ZINI ; Patrik MICHEL ; Yannick BÉJOT ; Andreas KASTRUP ; Marialuisa ZEDDE ; Georg KÄGI ; Lars KELLERT ; Hilde HENON ; Sami CURTZE ; Alessandro PEZZINI ; Marcel ARNOLD ; Susanne WEGENER ; Peter RINGLEB ; Turgut TATLISUMAK ; Paul J. NEDERKOORN ; Stefan T. ENGELTER ; Henrik GENSICKE ;
Journal of Stroke 2023;25(2):272-281
Background:
and Purpose This study aimed to investigate the effect of endovascular treatment (EVT, with or without intravenous thrombolysis [IVT]) versus IVT alone on outcomes in patients with acute ischemic stroke (AIS) and intracranial large vessel occlusion (LVO) attributable to cervical artery dissection (CeAD).
Methods:
This multinational cohort study was conducted based on prospectively collected data from the EVA-TRISP (EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients) collaboration. Consecutive patients (2015–2019) with AIS-LVO attributable to CeAD treated with EVT and/or IVT were included. Primary outcome measures were (1) favorable 3-month outcome (modified Rankin Scale score 0–2) and (2) complete recanalization (thrombolysis in cerebral infarction scale 2b/3). Odds ratios with 95% confidence intervals (OR [95% CI]) from logistic regression models were calculated (unadjusted, adjusted). Secondary analyses were performed in the patients with LVO in the anterior circulation (LVOant) including propensity score matching.
Results:
Among 290 patients, 222 (76.6%) had EVT and 68 (23.4%) IVT alone. EVT-treated patients had more severe strokes (National Institutes of Health Stroke Scale score, median [interquartile range]: 14 [10–19] vs. 4 [2–7], P<0.001). The frequency of favorable 3-month outcome did not differ significantly between both groups (EVT: 64.0% vs. IVT: 86.8%; ORadjusted 0.56 [0.24–1.32]). EVT was associated with higher rates of recanalization (80.5% vs. 40.7%; ORadjusted 8.85 [4.28–18.29]) compared to IVT. All secondary analyses showed higher recanalization rates in the EVT-group, which however never translated into better functional outcome rates compared to the IVT-group.
Conclusion
We observed no signal of superiority of EVT over IVT regarding functional outcome in CeAD-patients with AIS and LVO despite higher rates of complete recanalization with EVT. Whether pathophysiological CeAD-characteristics or their younger age might explain this observation deserves further research.