Recanalization Therapies for Large Vessel Occlusion Due to Cervical Artery Dissection: A Cohort Study of the EVA-TRISP Collaboration.

IF 6 1区医学 Q1 CLINICAL NEUROLOGY

Journal of Stroke Pub Date : 2023-05-01 DOI:10.5853/jos.2022.03370

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

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引用次数: 0

Abstract

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.

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颈动脉夹层所致大血管闭塞的再通治疗:EVA-TRISP合作的队列研究。

背景与目的:本研究旨在探讨血管内治疗(EVT，联合或不联合静脉溶栓[IVT])与单纯静脉溶栓对急性缺血性卒中(AIS)合并颈动脉夹层(CeAD)所致颅内大血管闭塞(LVO)患者预后的影响。方法:这项跨国队列研究基于前瞻性收集的EVA-TRISP(缺血性卒中患者血管内治疗和溶栓)合作数据进行。纳入了连续接受EVT和/或IVT治疗的归因于CeAD的AIS-LVO患者(2015-2019)。主要结局指标为(1)3个月的良好预后(改良Rankin量表评分0-2)和(2)完全再通(脑梗死评分2b/3)。计算逻辑回归模型的95%置信区间(OR [95% CI])的优势比(未调整，调整)。对前循环LVO患者(LVOant)进行二次分析，包括倾向评分匹配。结果:290例患者中，222例(76.6%)行EVT, 68例(23.4%)单独行EVT。EVT治疗的患者有更严重的卒中(美国国立卫生研究院卒中量表评分，中位数[四分位数范围]:14[10-19]对4[2-7])。结论:我们没有观察到EVT优于IVT的信号，尽管EVT的完全再通率更高。病理生理特征或他们的年轻年龄是否可以解释这一观察结果值得进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke CLINICAL NEUROLOGYPERIPHERAL VASCULAR DISE-PERIPHERAL VASCULAR DISEASE

CiteScore

11.00

自引率

3.70%

发文量

审稿时长

12 weeks

期刊介绍： The Journal of Stroke (JoS) is a peer-reviewed publication that focuses on clinical and basic investigation of cerebral circulation and associated diseases in stroke-related fields. Its aim is to enhance patient management, education, clinical or experimental research, and professionalism. The journal covers various areas of stroke research, including pathophysiology, risk factors, symptomatology, imaging, treatment, and rehabilitation. Basic science research is included when it provides clinically relevant information. The JoS is particularly interested in studies that highlight characteristics of stroke in the Asian population, as they are underrepresented in the literature. The JoS had an impact factor of 8.2 in 2022 and aims to provide high-quality research papers to readers while maintaining a strong reputation. It is published three times a year, on the last day of January, May, and September. The online version of the journal is considered the main version as it includes all available content. Supplementary issues are occasionally published. The journal is indexed in various databases, including SCI(E), Pubmed, PubMed Central, Scopus, KoreaMed, Komci, Synapse, Science Central, Google Scholar, and DOI/Crossref. It is also the official journal of the Korean Stroke Society since 1999, with the abbreviated title J Stroke.