Bridging therapy is associated with improved cognitive function after large vessel occlusion stroke - an analysis of the German Stroke Registry.
Cognitive function
Intravenous thrombolysis
Ischemic stroke
LVOS
Mechanical thrombectomy
Journal
Neurological research and practice
ISSN: 2524-3489
Titre abrégé: Neurol Res Pract
Pays: England
ID NLM: 101767802
Informations de publication
Date de publication:
2020
2020
Historique:
received:
14
02
2020
accepted:
13
03
2020
entrez:
16
12
2020
pubmed:
17
12
2020
medline:
17
12
2020
Statut:
epublish
Résumé
The targeted use of endovascular therapy (EVT), with or without intravenous thrombolysis (IVT) in acute large cerebral vessel occlusion stroke (LVOS) has been proven to be superior compared to IVT alone. Despite favorable functional outcome, many patients complain about cognitive decline after EVT. If IVT in addition to EVT has positive effects on cognitive function is unclear. We analyzed data from the German Stroke Registry (GSR, an open, multicenter and prospective observational study) and compared cognitive function 90 days after index ischemic stroke using MoCA in patients with independent (mRS ≤ 2 pts) and excellent (mRS = 0 pts) functional outcome receiving combined EVT and IVT (EVT + IVT) vs. EVT alone (EVT-IVT). Of the 2636 GSR patients, we included 166 patients with mRS ≤ 2 at 90 days in our analysis. Of these, 103 patients (62%) received EVT + IVT, 63 patients (38%) were treated with EVT alone. There was no difference in reperfusion status between groups (mTICI ≥ 2b in both groups at 95%, In Patients with good functional outcome after LVOS, rates of cognitive impairment are lower with combined EVT and IVT compared to EVT alone. ClinicalTrials.gov Identifier: NCT03356392.
Sections du résumé
BACKGROUND
BACKGROUND
The targeted use of endovascular therapy (EVT), with or without intravenous thrombolysis (IVT) in acute large cerebral vessel occlusion stroke (LVOS) has been proven to be superior compared to IVT alone. Despite favorable functional outcome, many patients complain about cognitive decline after EVT. If IVT in addition to EVT has positive effects on cognitive function is unclear.
METHODS
METHODS
We analyzed data from the German Stroke Registry (GSR, an open, multicenter and prospective observational study) and compared cognitive function 90 days after index ischemic stroke using MoCA in patients with independent (mRS ≤ 2 pts) and excellent (mRS = 0 pts) functional outcome receiving combined EVT and IVT (EVT + IVT) vs. EVT alone (EVT-IVT).
RESULTS
RESULTS
Of the 2636 GSR patients, we included 166 patients with mRS ≤ 2 at 90 days in our analysis. Of these, 103 patients (62%) received EVT + IVT, 63 patients (38%) were treated with EVT alone. There was no difference in reperfusion status between groups (mTICI ≥ 2b in both groups at 95%,
CONCLUSIONS
CONCLUSIONS
In Patients with good functional outcome after LVOS, rates of cognitive impairment are lower with combined EVT and IVT compared to EVT alone.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov Identifier: NCT03356392.
Identifiants
pubmed: 33324931
doi: 10.1186/s42466-020-00079-9
pii: 79
pmc: PMC7650060
doi:
Banques de données
ClinicalTrials.gov
['NCT03356392']
Types de publication
Journal Article
Langues
eng
Pagination
29Informations de copyright
© The Author(s) 2020.
Déclaration de conflit d'intérêts
Competing interestsThe authors declare that they have no competing interests.
Références
Acta Neurol Scand. 2017 Jun;135(6):603-607
pubmed: 27412470
Stroke. 2017 Dec;48(12):3282-3288
pubmed: 29114095
J Neurol. 2011 Jun;258(6):1021-5
pubmed: 21181183
N Engl J Med. 2015 Jan 1;372(1):11-20
pubmed: 25517348
Neurology. 2017 Jan 17;88(3):245-251
pubmed: 27940648
Alzheimers Dement. 2015 Jun;11(6):718-26
pubmed: 26045020
J Neurointerv Surg. 2019 Jan;11(1):20-27
pubmed: 29705773
BMC Neurol. 2015 Mar 12;15:31
pubmed: 25879880
Stroke. 2004 Jun;35(6):1264-8
pubmed: 15118167
Lancet Neurol. 2019 Mar;18(3):223-225
pubmed: 30784546
Curr Opin Neurol. 2019 Feb;32(1):3-12
pubmed: 30461464
BMC Med. 2017 Jan 18;15(1):11
pubmed: 28095900
Neurology. 2009 Dec 1;73(22):1866-72
pubmed: 19949033
N Engl J Med. 2015 Jun 11;372(24):2285-95
pubmed: 25882376
Neuroepidemiology. 2015;45(3):161-76
pubmed: 26505981
J Int Neuropsychol Soc. 2009 Nov;15(6):915-23
pubmed: 19891821
Stroke. 2016 Apr;47(4):1037-44
pubmed: 26906917
J Stroke Cerebrovasc Dis. 2016 Dec;25(12):2868-2875
pubmed: 27569709
J Am Heart Assoc. 2018 Jan 15;7(2):
pubmed: 29335318
N Engl J Med. 2015 Mar 12;372(11):1019-30
pubmed: 25671798
Lancet Neurol. 2009 Nov;8(11):1006-18
pubmed: 19782001
Stroke. 2013 Jan;44(1):227-9
pubmed: 23138443
Stroke. 2013 Jan;44(1):138-45
pubmed: 23150656
Lancet Neurol. 2019 Mar;18(3):248-258
pubmed: 30784556
Nat Rev Neurol. 2017 Mar;13(3):148-159
pubmed: 28211452
N Engl J Med. 2015 Mar 12;372(11):1009-18
pubmed: 25671797
Stroke. 2017 Nov;48(11):2919-2921
pubmed: 29042491
World Neurosurg. 2018 Jun;114:e165-e172
pubmed: 29510288
Clin Geriatr Med. 2018 Nov;34(4):505-513
pubmed: 30336985
Stroke. 2005 Dec;36(12):2670-5
pubmed: 16254227
J Am Geriatr Soc. 2002 Apr;50(4):700-6
pubmed: 11982671
Stroke. 2018 Apr;49(4):987-994
pubmed: 29581343
Eur Stroke J. 2019 Jun;4(2):160-171
pubmed: 31259264
Stroke. 2011 Nov;42(11):3116-21
pubmed: 21903955
Cerebrovasc Dis. 2016;42(1-2):1-9
pubmed: 26886189
Exp Ther Med. 2017 Mar;13(3):909-912
pubmed: 28450918
Lancet. 1997 Jun 21;349(9068):1793-6
pubmed: 9269213
Int J Stroke. 2014 Oct;9 Suppl A100:48-54
pubmed: 25352473
N Engl J Med. 2015 Jun 11;372(24):2296-306
pubmed: 25882510
Stat Methods Med Res. 1999 Mar;8(1):3-15
pubmed: 10347857
Eur J Neurol. 2015 Sep;22(9):1288-94
pubmed: 26040251
Medicine (Baltimore). 2019 Apr;98(14):e14956
pubmed: 30946319
Med Clin (Barc). 2017 Sep 8;149(5):203-208
pubmed: 28416227
J Neurol Neurosurg Psychiatry. 1994 Feb;57(2):202-7
pubmed: 8126506
Cochrane Database Syst Rev. 2016 Nov 21;11:CD011333
pubmed: 27869298