Recanalization Therapies for Large Vessel Occlusion Due to Cervical Artery Dissection: A Cohort Study of the EVA-TRISP Collaboration
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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 (LVO<sub>ant</sub>) 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], <i>P</i><0.001). The frequency of favorable 3-month outcome did not differ significantly between both groups (EVT: 64.0% vs. IVT: 86.8%; OR<sub>adjusted</sub> 0.56 [0.24–1.32]). EVT was associated with higher rates of recanalization (80.5% vs. 40.7%; OR<sub>adjusted</sub> 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.
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 (LVO<sub>ant</sub>) 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], <i>P</i><0.001). The frequency of favorable 3-month outcome did not differ significantly between both groups (EVT: 64.0% vs. IVT: 86.8%; OR<sub>adjusted</sub> 0.56 [0.24–1.32]). EVT was associated with higher rates of recanalization (80.5% vs. 40.7%; OR<sub>adjusted</sub> 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.
참고문헌 (30)
- Debette S, "Cervical-artery dissections: predisposing factors, diagnosis, and outcome", Lancet Neurol, 8, pp.668~678 (2009)
- Engelter ST, "Cervical and intracranial artery dissections", Ther Adv Neurol Disord, 14, pp.17562864211037238~ (2021)
- Berkhemer OA, "A randomized trial of intraarterial treatment for acute ischemic stroke", N Engl J Med, 372, pp.11~20 (2015)
- Jovin TG, "Thrombectomy within 8 hours after symptom onset in ischemic stroke", N Engl J Med, 372, pp.2296~2306 (2015)
- Campbell BC, "Endovascular therapy for ischemic stroke with perfusion-imaging selection", N Engl J Med, 372, pp.1009~1018 (2015)
- Goyal M, "Randomized assessment of rapid endovascular treatment of ischemic stroke", N Engl J Med, 372, pp.1019~1030 (2015)
- Saver JL, "Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke", N Engl J Med, 372, pp.2285~2295 (2015)
- Jovin TG, "Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion", N Engl J Med, 387, pp.1373~1384 (2022)
- Tao C, "Trial of endovascular treatment of acute basilar-artery occlusion", N Engl J Med, 387, pp.1361~1372 (2022)
- Lin J, "Endovascular therapy versus intravenous thrombolysis in cervical artery dissection-related ischemic stroke : a meta-analysis", J Neurol, 267, pp.1585~1593 (2020)
- Goyal M, "Endovascular thrombectomy after largevessel ischaemic stroke : a meta-analysis of individual patient data from five randomised trials", Lancet, 387, pp.1723~1731 (2016)
- Nordanstig A, "EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients(EVA-TRISP)registry : basis and methodology of a pan-European prospective ischaemic stroke revascularisation treatment registry", BMJ Open, 11, pp.e042211~ (2021)
- Scheitz JF, "Cohort profile : thrombolysis in ischemic stroke patients(TRISP) : a multicentre research collaboration", BMJ Open, 8, pp.e023265~ (2018)
- Polymeris AA, "Intravenous thrombolysis for suspected ischemic stroke with seizure at onset", Ann Neurol, 86, pp.770~779 (2019)
- Gensicke H, "Intravenous thrombolysis and platelet count", Neurology, 90, pp.e690~e697 (2018)
- Traenka C, "Artery occlusion independently predicts unfavorable outcome in cervical artery dissection", Neurology, 94, pp.e170~e180 (2020)
- Altersberger VL, "Effect of haemoglobin levels on outcome in intravenous thrombolysis-treated stroke patients", Eur Stroke J, 5, pp.138~147 (2020)
- Lyden P, "Improved reliability of the NIH stroke scale using video training", Stroke, 25, pp.2220~2226 (1994)
- Zaidat OO, "Recommendations on angiographic revascularization grading standards for acute ischemic stroke : a consensus statement", Stroke, 44, pp.2650~2663 (2013)
- Hacke W, "Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke(ECASS II)", Lancet, 352, pp.1245~1251 (1998)
- Traenka C, "Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke – Results from the SWISS registry", Eur Stroke J, 3, pp.47~56 (2018)
- Compagne KCJ, "Acute endovascular treatment of patients with ischemic stroke from intracranial large vessel occlusion and extracranial carotid dissection", Front Neurol, 10, pp.102~ (2019)
- Gory B, "Thrombectomy in acute stroke with tandem occlusions from dissection versus atherosclerotic cause", Stroke, 48, pp.3145~3148 (2017)
- Wiegers EJA, "Clinical and imaging determinants of collateral status in patients with acute ischemic stroke in MR CLEAN trial and registry", Stroke, 51, pp.1493~1502 (2020)
- Mahncke HW, "Brain plasticity and functional losses in the aged : scientific bases for a novel intervention", Prog Brain Res, 157, pp.81~109 (2006)
- Manno C, "Outcome of endovascular therapy in stroke with large vessel occlusion and mild symptoms", Neurology, 93, pp.e1618~e1626 (2019)
- Seners P, "Bridging therapy or IV thrombolysis in minor stroke with large vessel occlusion", Ann Neurol, 88, pp.160~169 (2020)
- Yeo LL, "Outcomes in young adults with acute ischemic stroke undergoing endovascular thrombectomy : a real-world multicenter experience", Eur J Neurol, 28, pp.2736~2744 (2021)
- Turc G, "European Stroke Organisation(ESO)-European Society for Minimally Invasive Neurological Therapy(ESMINT)guidelines on mechanical thrombectomy in acute ischaemic stroke endorsed by Stroke Alliance for Europe(SAFE)", Eur Stroke J, 4, pp.6~12 (2019)
- Marnat G, "Safety and outcome of carotid dissection stenting during the treatment of tandem occlusions : a pooled analysis of TITAN and ETIS", Stroke, 51, pp.3713~3718 (2020)