1.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.
Result Analysis
Print
Save
E-mail