Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis.

IF 4.5 1区医学 Q1 NEUROIMAGING

Journal of NeuroInterventional Surgery Pub Date : 2024-09-24 DOI:10.1136/jnis-2024-022374

Huanwen Chen, Marco Colasurdo, Mihir Khunte, Ajay Malhotra, Dheeraj Gandhi

{"title":"Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis.","authors":"Huanwen Chen, Marco Colasurdo, Mihir Khunte, Ajay Malhotra, Dheeraj Gandhi","doi":"10.1136/jnis-2024-022374","DOIUrl":null,"url":null,"abstract":"Background: The safety and efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes associated with infective endocarditis (IE) compared with medical management (MM) is unclear.Methods: In this nationwide analysis of hospitalizations in the United States, we assessed the outcomes of EVT versus medical management (MM) for patients with LVO and IE. Primary outcome was routine home discharge with self-care. Secondary outcomes include home discharge, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Propensity score matching (PSM) was performed to adjust for confounders. Additional multivariable adjustments were performed for doubly robust analyses.Results: 2574 patients were identified; 656 (25.5%) received EVT. After PSM, the rate of routine discharge was significantly higher for patients with EVT compared with MM (14.6% vs 8.5%, p=0.021), and patients with EVT had significantly higher rate of home discharge (34.5% vs 26.5%, p=0.041), lower rate of in-hospital death (14.8% vs 25.2%, p=0.002), and lower rate of ICH (15.8% vs 23.1%, p=0.039). EVT was not associated with a different rate of SAH compared with MM (11.2% vs 7.9%, p=0.17). These associations remained unchanged with additional multivariable adjustments.Conclusion: For patients with LVO stroke and IE, EVT was associated with significantly higher odds of favorable hospitalization outcomes and lower odds of ICH compared with MM.","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5000,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of NeuroInterventional Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/jnis-2024-022374","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NEUROIMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The safety and efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes associated with infective endocarditis (IE) compared with medical management (MM) is unclear.

Methods: In this nationwide analysis of hospitalizations in the United States, we assessed the outcomes of EVT versus medical management (MM) for patients with LVO and IE. Primary outcome was routine home discharge with self-care. Secondary outcomes include home discharge, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Propensity score matching (PSM) was performed to adjust for confounders. Additional multivariable adjustments were performed for doubly robust analyses.

Results: 2574 patients were identified; 656 (25.5%) received EVT. After PSM, the rate of routine discharge was significantly higher for patients with EVT compared with MM (14.6% vs 8.5%, p=0.021), and patients with EVT had significantly higher rate of home discharge (34.5% vs 26.5%, p=0.041), lower rate of in-hospital death (14.8% vs 25.2%, p=0.002), and lower rate of ICH (15.8% vs 23.1%, p=0.039). EVT was not associated with a different rate of SAH compared with MM (11.2% vs 7.9%, p=0.17). These associations remained unchanged with additional multivariable adjustments.

Conclusion: For patients with LVO stroke and IE, EVT was associated with significantly higher odds of favorable hospitalization outcomes and lower odds of ICH compared with MM.

查看原文本刊更多论文

大血管卒中合并感染性心内膜炎患者的血管内血栓切除术与药物治疗。

背景：与药物治疗（MM）相比，血管内血栓切除术（EVT）治疗伴有感染性心内膜炎（IE）的大血管闭塞（LVO）脑卒中的安全性和有效性尚不明确：在这项对美国住院患者进行的全国性分析中，我们评估了 EVT 与药物治疗 (MM) 对 LVO 和 IE 患者的治疗效果。主要结果是常规出院回家自我护理。次要结果包括出院回家、院内死亡率、脑出血（ICH）和蛛网膜下腔出血（SAH）。进行倾向评分匹配（PSM）以调整混杂因素。结果：共确定了 2574 例患者，其中 656 例（25.5%）接受了 EVT。PSM后，与MM相比，EVT患者的常规出院率明显更高（14.6% vs 8.5%，P=0.021），EVT患者的家庭出院率明显更高（34.5% vs 26.5%，P=0.041），院内死亡率更低（14.8% vs 25.2%，P=0.002），ICH率更低（15.8% vs 23.1%，P=0.039）。与MM相比，EVT与SAH发生率无关（11.2% vs 7.9%，P=0.17）。这些关联在进行额外的多变量调整后保持不变：结论：对于 LVO 脑卒中和 IE 患者，与 MM 相比，EVT 与较高的住院预后良好几率和较低的 ICH 几率相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of NeuroInterventional Surgery NEUROIMAGING-SURGERY

CiteScore

9.50

自引率

14.60%

发文量

291

审稿时长

4-8 weeks

期刊介绍： The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.