Outcomes after reperfusion therapies in patients with ACA stroke: A multicenter cohort study from the EVATRISP collaboration.

Brain Ischemia / complications Cohort Studies Endovascular Procedures Fibrinolytic Agents / therapeutic use Humans Reperfusion Stroke / drug therapy Thrombectomy Thrombolytic Therapy Treatment Outcome
Anterior cerebral artery Cerebrovascular disease Endovascular Stroke Thrombectomy

Journal

Journal of the neurological sciences
ISSN: 1878-5883
Titre abrégé: J Neurol Sci
Pays: Netherlands
ID NLM: 0375403

Informations de publication

Date de publication:
15 Jan 2022
Historique:
received: 10 10 2021
revised: 28 11 2021
accepted: 01 12 2021
pubmed: 18 12 2021
medline: 29 1 2022
entrez: 17 12 2021
Statut: ppublish

Résumé

Patients with stroke secondary to occlusions of the anterior cerebral artery (ACA) often have poor outcomes. The optimal acute therapeutic intervention for these patients remains unknown. Patients with isolated ACA-stroke were identified from 10 centers participating in the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) prospective registry. Patients treated with endovascular thrombectomy (EVT) were compared to those treated with intravenous thrombolysis (IVT). Odds ratios with 95% confidence intervals (OR; 95%CI) were calculated using multivariate regression analysis. Included were 92 patients with ACA-stroke. Of the 92 ACA patients, 55 (60%) were treated with IVT only and 37 (40%) with EVT (±bridging IVT). ACA patients treated with EVT had more often wake-up stroke (24% vs. 6%, p = 0.044) and proximal ACA occlusions (43% vs. 24%, p = 0.047) and tended to have higher stroke severity on admission [NIHSS: 10.0 vs 7.0, p = 0.054). However, odds for favorable outcome, mortality or symptomatic intracranial hemorrhage did not differ significantly between both groups. Exploration of the effect of clot location inside the ACA showed that in patients with A1 or A2/A3 ACA occlusions the chances of favorable outcome were not influenced by treatment allocation to IVT or EVT. Treatment with either IVT or EVT could be safe with similar effect in patients with ACA-strokes and these effects may be independent of clot location within the occluded ACA.

Sections du résumé

BACKGROUND BACKGROUND
Patients with stroke secondary to occlusions of the anterior cerebral artery (ACA) often have poor outcomes. The optimal acute therapeutic intervention for these patients remains unknown.
METHODS METHODS
Patients with isolated ACA-stroke were identified from 10 centers participating in the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) prospective registry. Patients treated with endovascular thrombectomy (EVT) were compared to those treated with intravenous thrombolysis (IVT). Odds ratios with 95% confidence intervals (OR; 95%CI) were calculated using multivariate regression analysis.
RESULTS RESULTS
Included were 92 patients with ACA-stroke. Of the 92 ACA patients, 55 (60%) were treated with IVT only and 37 (40%) with EVT (±bridging IVT). ACA patients treated with EVT had more often wake-up stroke (24% vs. 6%, p = 0.044) and proximal ACA occlusions (43% vs. 24%, p = 0.047) and tended to have higher stroke severity on admission [NIHSS: 10.0 vs 7.0, p = 0.054). However, odds for favorable outcome, mortality or symptomatic intracranial hemorrhage did not differ significantly between both groups. Exploration of the effect of clot location inside the ACA showed that in patients with A1 or A2/A3 ACA occlusions the chances of favorable outcome were not influenced by treatment allocation to IVT or EVT.
DISCUSSION CONCLUSIONS
Treatment with either IVT or EVT could be safe with similar effect in patients with ACA-strokes and these effects may be independent of clot location within the occluded ACA.

Identifiants

DOI: 10.1016/j.jns.2021.120081 PMID: 34920158
pubmed: 34920158
pii: S0022-510X(21)02783-0
doi: 10.1016/j.jns.2021.120081
pii:
doi:

Substances chimiques

Fibrinolytic Agents 0

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

120081

Informations de copyright

Copyright © 2021 Elsevier B.V. All rights reserved.

Auteurs

A Filioglo (A)

Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

N Simaan (N)

Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

A Honig (A)

Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

M R Heldner (MR)

Department of Neurology, University Hospital Bern, Switzerland.

R von Rennenberg (R)

Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.

A Pezzini (A)

Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy.

V Padjen (V)

Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

A Rentzos (A)

Department of Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital and Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden.

V L Altersberger (VL)

Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland.

P Baumgartner (P)

University Hospital Zurich and University of Zurich, Switzerland.

A Zini (A)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy.

I Grisendi (I)

Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.

S Aladdin (S)

Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

J M Gomori (JM)

Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

S M Pilgram-Pastor (SM)

University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.

J F Scheitz (JF)

Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.

M Magoni (M)

U.O Vascular Neurology, Stroke Unit, ASST Spedali Civili, Brescia, Italy.

I Berisavac (I)

Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

A Nordanstig (A)

Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.

M Psychogios (M)

Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland.

A Luft (A)

University Hospital Zurich and University of Zurich, Switzerland.

M Gentile (M)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy.

F Assenza (F)

Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.

M Arnold (M)

Department of Neurology, University Hospital Bern, Switzerland.

C H Nolte (CH)

Department of Neurology, Charité-Universitätsmedizin Berlin, Center for Stroke Research, Berlin, Berlin Institute of Health, Berlin, Germany.

M Gamba (M)

University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.

M Ercegovac (M)

Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

K Jood (K)

Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.

S T Engelter (ST)

Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland.

S Wegener (S)

University Hospital Zurich and University of Zurich, Switzerland.

S Forlivesi (S)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy.

M Zedde (M)

Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.

H Gensicke (H)

Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland.

T Tatlisumak (T)

Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.

J E Cohen (JE)

Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

R R Leker (RR)

Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: leker@hadassah.org.il.

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Classifications MeSH

questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Outcomes after reperfusion therapies in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Outcomes after reperfusion therapies in...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › Outcomes after reperfusion therapies in...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Fibrinolytiques › Outcomes after reperfusion therapies in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Outcomes after reperfusion therapies in...
questionsmedicales.fr › Techniques d'investigation › Perfusion › Reperfusion › Outcomes after reperfusion therapies in...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Outcomes after reperfusion therapies in...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie cardiovasculaire › Procédures de chirurgie vasculaire › Thrombectomie › Outcomes after reperfusion therapies in...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Traitement thrombolytique › Outcomes after reperfusion therapies 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 › Outcomes after reperfusion therapies in...