Marek Sykora, Sven Poli, Michael Giannakakis, Joshua Mbroh, Alexandra Gomez Exposito, Stefan Krebs, Alexandra Posekany, Mira Katan, Susanne Wegener, Gian Marco De Marchis, Thomas Gattringer, Hannes A Deutschmann, Lukas Mayer-Suess, Jens Fiehler, Ulrike Ernemann, Florian Hennersdorf, Tomas Dobrocky, Zsolt Kulcsár, Pasquale Mordasini, Marios Psychogios, Christian Loewe, Elke R Gizewski, Christian H Nolte, Christian Neumann, Urs Fischer, Julia Ferrari
{"title":"Functional Outcome in Patients With Carotid Artery Dissection Undergoing Thrombectomy or Standard Medical Treatment.","authors":"Marek Sykora, Sven Poli, Michael Giannakakis, Joshua Mbroh, Alexandra Gomez Exposito, Stefan Krebs, Alexandra Posekany, Mira Katan, Susanne Wegener, Gian Marco De Marchis, Thomas Gattringer, Hannes A Deutschmann, Lukas Mayer-Suess, Jens Fiehler, Ulrike Ernemann, Florian Hennersdorf, Tomas Dobrocky, Zsolt Kulcsár, Pasquale Mordasini, Marios Psychogios, Christian Loewe, Elke R Gizewski, Christian H Nolte, Christian Neumann, Urs Fischer, Julia Ferrari","doi":"10.1212/WNL.0000000000213465","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Whether thrombectomy compared with best medical treatment (BMT) improves outcome in patients with stroke and carotid artery dissection (CAD) is unknown.</p><p><strong>Methods: </strong>This was an international observational study based on prospective nationwide Austrian, German, and Swiss stroke registries. Patients with large vessel occlusion (LVO) due to CAD were compared according to treatment modality (thrombectomy vs BMT including intravenous thrombolysis) and to admission stroke severity NIH Stroke Scale (NIHSS) <6 vs NIHSS ≥6. The primary outcome was the favorable functional outcome (modified Rankin Score 0-2) at 3 months.</p><p><strong>Results: </strong>Of 1,023 patients (mean age 54 years, 72% males), 516 received thrombectomy and 507 received BMT. After robust adjustment, thrombectomy was associated with favorable outcome in patients presenting with NIHSS ≥6 (adjusted risk ratio (aRR) = 1.77, 95% CI 1.44-2.17). In those presenting with NIHSS <6, thrombectomy was associated with unfavorable outcome (aRR 1.68, CI 1.1-2.56) as compared with BMT.</p><p><strong>Discussion: </strong>Thrombectomy improved functional outcome in patients with LVO due to CAD and admission NIHSS ≥6, but not NIHSS <6 points.</p><p><strong>Classification of evidence: </strong>This study provides Class III evidence that for patients with LVO due to CAD and admission NIHSS ≥6 points, thrombectomy compared with BMT significantly increases the probability of favorable outcome.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 7","pages":"e213465"},"PeriodicalIF":7.7000,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1212/WNL.0000000000213465","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/14 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objectives: Whether thrombectomy compared with best medical treatment (BMT) improves outcome in patients with stroke and carotid artery dissection (CAD) is unknown.
Methods: This was an international observational study based on prospective nationwide Austrian, German, and Swiss stroke registries. Patients with large vessel occlusion (LVO) due to CAD were compared according to treatment modality (thrombectomy vs BMT including intravenous thrombolysis) and to admission stroke severity NIH Stroke Scale (NIHSS) <6 vs NIHSS ≥6. The primary outcome was the favorable functional outcome (modified Rankin Score 0-2) at 3 months.
Results: Of 1,023 patients (mean age 54 years, 72% males), 516 received thrombectomy and 507 received BMT. After robust adjustment, thrombectomy was associated with favorable outcome in patients presenting with NIHSS ≥6 (adjusted risk ratio (aRR) = 1.77, 95% CI 1.44-2.17). In those presenting with NIHSS <6, thrombectomy was associated with unfavorable outcome (aRR 1.68, CI 1.1-2.56) as compared with BMT.
Discussion: Thrombectomy improved functional outcome in patients with LVO due to CAD and admission NIHSS ≥6, but not NIHSS <6 points.
Classification of evidence: This study provides Class III evidence that for patients with LVO due to CAD and admission NIHSS ≥6 points, thrombectomy compared with BMT significantly increases the probability of favorable outcome.
期刊介绍：
Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology.
As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content.
Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.
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