Τίτλος:
Intravenous thrombolysis + endovascular thrombectomy versus thrombolysis alone in large vessel occlusion mild stroke: a propensity score matched analysis
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background and purpose: The best reperfusion treatment for patients with mild acute ischaemic stroke harbouring proximal anterior circulation large vessel occlusion (LVO) is unknown. The aim was to compare the safety and efficacy of intravenous thrombolysis (IVT) plus endovascular thrombectomy (EVT) versus IVT alone in LVO patients with mild symptoms. Methods: From the Safe Implementation of Treatment in Stroke–International Stroke Thrombolysis and Thrombectomy Register (SITS-ISTR), were included: (i) consecutive acute ischaemic stroke patients, (ii) treated within 4.5 h from symptoms onset, (iii) baseline National Institutes of Health Stroke Scale (NIHSS) score ≤5 and (iv) intracranial internal carotid artery [ICA], M1 or T occlusion [defined as occlusion of ICA terminal bifurcation]. After propensity score matching, 3-month functional outcomes (modified Rankin Scale [mRS] 0–1 and 0–2) and safety outcomes (symptomatic intracerebral haemorrhage and death) were compared (via univariable and multivariable logistic [and ordinal] regression analyses) in patients treated with IVT + EVT versus IVT alone. Results: In all, 1037 patients were included. After propensity score matching (n = 312 per group), IVT + EVT was independently associated with poor functional outcomes (adjusted odds ratio [aOR] 0.46 for mRS 0–1, 95% confidence interval [CI] 0.30–0.72, p = 0.001; aOR 0.52 for mRS 0–2, 95% CI 0.32–0.84, p = 0.007; aOR 1.61 for 1-point shift in mRS score, 95% CI 1.12–2.32, p = 0.011), with no significant differences in safety outcomes compared to IVT alone, despite numerically higher rates of symptomatic intracerebral haemorrhage (3.3% vs. 1.1%; p = 0.082), a higher rate of any haemorrhagic transformation (17.6% vs. 7.3%; p < 0.001) and subarachnoid haemorrhage (7.9% vs. 1.5%; p = 0.002) in the IVT + EVT group. Discussion: In anterior circulation LVO patients presenting with NIHSS score ≤5, IVT + EVT (vs. IVT alone) was associated with poorer 3-month functional outcome. Randomized controlled trials are needed to elucidate the best treatments in mild LVO patients. © 2023 European Academy of Neurology.
Συγγραφείς:
Schwarz, G.
Bonato, S.
Lanfranconi, S.
Matusevicius, M.
Ghione, I.
Valcamonica, G.
Tsivgoulis, G.
Paiva Nunes, A.
Mancuso, M.
Zini, A.
Candelaresi, P.
Rand, V.-M.
Comi, G.P.
Mazya, M.V.
Ahmed, N.
Περιοδικό:
European Journal of Paediatric Neurology
Εκδότης:
John Wiley and Sons Inc
Λέξεις-κλειδιά:
fibrinolytic agent; fibrinolytic agent, acute ischemic stroke; aged; Article; blood vessel occlusion; brain hemorrhage; cerebrovascular accident; cohort analysis; comparative study; female; fibrinolytic therapy; human; internal carotid artery occlusion; large vessel occlusion; major clinical study; male; multicenter study; National Institutes of Health Stroke Scale; observational study; percutaneous thrombectomy; Rankin scale; retrospective study; safety; sensitivity analysis; subarachnoid hemorrhage; adverse event; brain hemorrhage; brain ischemia; cerebrovascular accident; endovascular surgery; fibrinolytic therapy; propensity score; thrombectomy; treatment outcome, Brain Ischemia; Cerebral Hemorrhage; Endovascular Procedures; Fibrinolytic Agents; Humans; Ischemic Stroke; Propensity Score; Stroke; Thrombectomy; Thrombolytic Therapy; Treatment Outcome
