Thrombectomy Technique Predicts Outcome in Posterior Circulation Stroke-Insights from the STAR Collaboration.

Aged Endovascular Procedures / instrumentation Female Humans Male Middle Aged Retrospective Studies Stroke / surgery Thrombectomy / instrumentation Treatment Outcome
Mechanical thrombectomy Posterior circulation Stroke

Journal

Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914

Informations de publication

Date de publication:
15 10 2020
Historique:
received: 26 07 2019
accepted: 17 03 2020
pubmed: 21 5 2020
medline: 2 3 2021
entrez: 21 5 2020
Statut: ppublish

Résumé

Randomized controlled trials evaluating mechanical thrombectomy (MT) for acute ischemic stroke predominantly studied anterior circulation patients. Both procedural and clinical predictors of outcome in posterior circulation patients have not been evaluated in large cohort studies. To investigate technical and clinical predictors of functional independence after posterior circulation MT while comparing different frontline thrombectomy techniques. In a retrospective multicenter international study of 3045 patients undergoing MT for stroke between 06/2014 and 12/2018, 345 patients had posterior circulation strokes. MT was performed using aspiration, stent retriever, or combined approach. Functional outcomes were assessed using the 90-d modified Rankin score dichotomized into good (0-2) and poor outcomes (3-6). We included 2700 patients with anterior circulation and 345 patients with posterior circulation strokes. Posterior patients (age: 60 ± 14, 46% females) presented with mainly basilar occlusion (80%) and were treated using contact aspiration or ADAPT (39%), stent retriever (31%) or combined approach (19%). Compared to anterior strokes, posterior strokes had delayed treatment (500 vs 340 min, P < .001), higher national institute of health stroke scale (NIHSS) (17.1 vs 15.7, P < .01) and lower rates of good outcomes (31% vs 43%, P < .01). In posterior MT, diabetes (OR = 0.28, 95%CI: 0.12-0.65), admission NIHSS (OR = 0.9, 95%CI: 0.86-0.94), and use of stent retriever (OR = 0.26, 95%CI: 0.11-0.62) or combined approach (OR = 0.35, 95%CI: 0.12-1.01) vs ADAPT were associated with lower odds of good outcome. Stent retriever use was associated with lower odds of good outcomes compared to ADAPT even when including patients with only basilar occlusion or with successful recanalization only. Despite similar safety profiles, use of ADAPT is associated with higher rates of functional independence after posterior circulation thrombectomy compared to stent retriever or combined approach in large "real-world" retrospective study.

Sections du résumé

BACKGROUND
Randomized controlled trials evaluating mechanical thrombectomy (MT) for acute ischemic stroke predominantly studied anterior circulation patients. Both procedural and clinical predictors of outcome in posterior circulation patients have not been evaluated in large cohort studies.
OBJECTIVE
To investigate technical and clinical predictors of functional independence after posterior circulation MT while comparing different frontline thrombectomy techniques.
METHODS
In a retrospective multicenter international study of 3045 patients undergoing MT for stroke between 06/2014 and 12/2018, 345 patients had posterior circulation strokes. MT was performed using aspiration, stent retriever, or combined approach. Functional outcomes were assessed using the 90-d modified Rankin score dichotomized into good (0-2) and poor outcomes (3-6).
RESULTS
We included 2700 patients with anterior circulation and 345 patients with posterior circulation strokes. Posterior patients (age: 60 ± 14, 46% females) presented with mainly basilar occlusion (80%) and were treated using contact aspiration or ADAPT (39%), stent retriever (31%) or combined approach (19%). Compared to anterior strokes, posterior strokes had delayed treatment (500 vs 340 min, P < .001), higher national institute of health stroke scale (NIHSS) (17.1 vs 15.7, P < .01) and lower rates of good outcomes (31% vs 43%, P < .01). In posterior MT, diabetes (OR = 0.28, 95%CI: 0.12-0.65), admission NIHSS (OR = 0.9, 95%CI: 0.86-0.94), and use of stent retriever (OR = 0.26, 95%CI: 0.11-0.62) or combined approach (OR = 0.35, 95%CI: 0.12-1.01) vs ADAPT were associated with lower odds of good outcome. Stent retriever use was associated with lower odds of good outcomes compared to ADAPT even when including patients with only basilar occlusion or with successful recanalization only.
CONCLUSION
Despite similar safety profiles, use of ADAPT is associated with higher rates of functional independence after posterior circulation thrombectomy compared to stent retriever or combined approach in large "real-world" retrospective study.

Identifiants

DOI: 10.1093/neuros/nyaa179 PMID: 32433730
pubmed: 32433730
pii: 5841237
doi: 10.1093/neuros/nyaa179
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

982-991

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2020 by the Congress of Neurological Surgeons.

Auteurs

Ali M Alawieh (AM)

Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.

Maya Eid (M)

Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.

Mohammad Anadani (M)

Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.

Mithun Sattur (M)

Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.

Ilko L Maier (IL)

Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.

Wuwei Feng (W)

Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.

Nitin Goyal (N)

Department of Neurology, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee.

Robert M Starke (RM)

Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida.

Ansaar Rai (A)

Department of Radiology, West Virginia University, Morgantown, West Virginia.

Kyle M Fargen (KM)

Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina.

Marios-Nikos Psychogios (MN)

Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany.
Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland.

Reade De Leacy (R)

Department of Neurosurgery, Mount Sinai Health System, New York, New York.

Jonathan A Grossberg (JA)

Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.

Salah G Keyrouz (SG)

Department of Neurology, Washington University in Saint Louis, St. Louis, Missouri.

Travis M Dumont (TM)

Department of Surgery, Division of Neurosurgery, Banner University of Arizona Medical Center, Tucson, Arizona.

Peter Kan (P)

Department of Neurology, Baylor College of medicine, Houston, Texas.

Jonathan Lena (J)

Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.

Jan Liman (J)

Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.

Adam S Arthur (AS)

Department of Neurology, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee.

Lucas Elijovich (L)

Department of Neurology, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee.

David J Mccarthy (DJ)

Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida.

Vasu Saini (V)

Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida.

Stacey Q Wolfe (SQ)

Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina.

J Mocco (J)

Department of Neurosurgery, Mount Sinai Health System, New York, New York.

Johanna T Fifi (JT)

Department of Neurosurgery, Mount Sinai Health System, New York, New York.

Fábio A Nascimento (FA)

Department of Neurology, Baylor College of medicine, Houston, Texas.

James A Giles (JA)

Department of Neurology, Washington University in Saint Louis, St. Louis, Missouri.

Michelle Allen (M)

Department of Neurology, Washington University in Saint Louis, St. Louis, Missouri.

Roberto Crosa (R)

Centro Endovascular Neurológico, Médica Uruguaya, Montevideo, Uruguay.

W Christopher Fox (WC)

Department of Neurosurgery, University of Florida, Gainesville, Florida.

Benjamin Gory (B)

Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France.

Alejandro M Spiotta (AM)

Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Thrombectomy Technique Predicts Outcome in...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › Thrombectomy Technique Predicts Outcome in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Thrombectomy Technique Predicts Outcome in...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Thrombectomy Technique Predicts Outcome in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Thrombectomy Technique Predicts Outcome in...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Thrombectomy Technique Predicts Outcome in...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie cardiovasculaire › Procédures de chirurgie vasculaire › Thrombectomie › Thrombectomy Technique Predicts Outcome in...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Thrombectomy Technique Predicts Outcome in...