Thrombectomy with or without Intravenous Thrombolytics in Basilar Artery Occlusion.
Humans
Basilar Artery
Brain Ischemia
Prospective Studies
Ischemic Stroke
/ etiology
Fibrinolytic Agents
/ adverse effects
Thrombectomy
/ adverse effects
Stroke
/ drug therapy
Thrombolytic Therapy
/ adverse effects
Intracranial Hemorrhages
/ etiology
Treatment Outcome
Endovascular Procedures
/ adverse effects
Journal
Annals of neurology
ISSN: 1531-8249
Titre abrégé: Ann Neurol
Pays: United States
ID NLM: 7707449
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
revised:
01
06
2023
received:
14
02
2023
accepted:
08
06
2023
medline:
5
9
2023
pubmed:
14
6
2023
entrez:
14
6
2023
Statut:
ppublish
Résumé
Two randomized trials demonstrated the benefit of endovascular therapy (EVT) in patients suffering from a stroke due to a basilar artery occlusion (BAO). However, intravenous thrombolytic (IVT) use before EVT was low in these trials, questioning the added value of this treatment in this setting. We sought to investigate the efficacy and safety of EVT alone compared to IVT + EVT in stroke patients with a BAO. We analyzed data from the Endovascular Treatment in Ischemic Stroke registry, a prospective, observational, multicenter study of acute ischemic stroke patients treated with EVT in 21 centers in France between 1 January 2015 and 31 December 2021. We included patients with BAO and/or intracranial vertebral artery occlusion and compared patients treated with EVT alone versus IVT + EVT after propensity score (PS) matching. Variables selected for the PS were pre-stroke mRS, dyslipidemia, diabetes, anticoagulation, admission mode, baseline NIHSS and ASPECTS, type of anesthesia, and time from symptom onset to puncture. Efficacy outcomes were good functional outcome (modified Rankin Scale [mRS] 0-3) and functional independence (mRS 0-2) at 90 days. Safety outcomes were symptomatic intracranial hemorrhages and all-cause mortality at 90 days. Among 385 patients, 243 (134 EVT alone and 109 IVT + EVT) were included after PS matching. There was no difference between EVT alone and IVT + EVT regarding good functional outcome (adjusted odd ratio [aOR] labeling = 1.27, 95% confidence interval [CI], 0.68-2.37, p = 0.45) and functional independence (aOR = 1.50, 95% CI, 0.79-2.85, p = 0.21). Symptomatic intracranial hemorrhage and all-cause mortality were also similar between the two groups (aOR = 0.42, 95% CI, 0.10-1.79, p = 0.24 and aOR = 0.56, 95% CI, 0.29-1.10, p = 0.09, respectively). In this PS matching analysis, EVT alone seemed to lead to similar neurological recovery than IVT + EVT, with comparable safety profile. However, given our sample size and the observational nature of this study, further studies are needed to confirm these findings. ANN NEUROL 2023;94:596-604.
Substances chimiques
Fibrinolytic Agents
0
Types de publication
Observational Study
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
596-604Informations de copyright
© 2023 American Neurological Association.
Références
Tao C, Nogueira RG, Zhu Y, et al. Trial of endovascular treatment of acute basilar-artery occlusion. N Engl J Med 2022;387:1361-1372.
Jovin TG, Li C, Wu L, et al. Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion. N Engl J Med 2022;387:1373-1384.
Langezaal LCM, van der Hoeven E, Mont'Alverne FJA, et al. Endovascular therapy for stroke due to basilar-artery occlusion. N Engl J Med 2021;384:1910-1920.
Schonewille WJ. Favorable outcomes in endovascular therapy for basilar-artery occlusion. N Engl J Med 2022;387:1428-1429.
Maier B, Desilles JP, Mazighi M. Intracranial hemorrhage after reperfusion therapies in acute ischemic stroke patients. Front Neurol 2020;11:599908.
Yang P, Zhang Y, Zhang L, et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med 2020;382:1981-1993.
Fischer U, Kaesmacher J, Strbian D, et al. Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Lancet 2022;400:104-115.
LeCouffe NE, Kappelhof M, Treurniet KM, et al. A randomized trial of intravenous alteplase before endovascular treatment for stroke. N Engl J Med 2021;385:1833-1844.
Mitchell PJ, Yan B, Churilov L, et al. Endovascular thrombectomy versus standard bridging thrombolytic with endovascular thrombectomy within 4.5 h of stroke onset: an open-label, blinded-endpoint, randomised non-inferiority trial. Lancet 2022;400:116-125.
Suzuki K, Matsumaru Y, Takeuchi M, et al. Effect of mechanical thrombectomy without vs with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke: the SKIP randomized clinical trial. JAMA 2021;325:244-253.
Zi W, Qiu Z, Li F, et al. Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional Independence in patients with acute ischemic stroke: the DEVT randomized clinical trial. JAMA 2021;325:234-243.
Boisseau W, Desilles JP, Fahed R, et al. Neutrophil count predicts poor outcome despite recanalization after endovascular therapy. Neurology 2019;93:e467-e475.
Campbell BCV, Kappelhof M, Fischer U. Role of intravenous thrombolytics prior to endovascular thrombectomy. Stroke 2022;53:2085-2092.
Seners P, Turc G, Maier B, et al. Incidence and predictors of early recanalization after intravenous thrombolysis: a systematic review and meta-analysis. Stroke 2016;47:2409-2412.
Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387:1723-1731.
Nappini S, Arba F, Pracucci G, et al. Bridging versus direct endovascular therapy in basilar artery occlusion. J Neurol Neurosurg Psychiatry 2021;92:956-962.
Siow I, Tan BYQ, Lee KS, et al. Bridging thrombolysis versus direct mechanical thrombectomy in stroke due to basilar artery occlusion. J Stroke 2022;24:128-137.
Nie X, Wang D, Pu Y, et al. Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion. Stroke Vasc Neurol 2022;7:190-199.
Kohli GS, Schartz D, Whyte R, et al. Endovascular thrombectomy with or without intravenous thrombolysis in acute basilar artery occlusion ischemic stroke: a meta-analysis. J Stroke Cerebrovasc Dis 2022 Dec;31:106847.
Roman LS, Menon BK, Blasco J, et al. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018;17:895-904.
Lindsberg PJ, Pekkola J, Strbian D, et al. Time window for recanalization in basilar artery occlusion: speculative synthesis. Neurology 2015;85:1806-1815.
Desilles JP, Loyau S, Syvannarath V, et al. Alteplase reduces downstream microvascular thrombosis and improves the benefit of large artery recanalization in stroke. Stroke 2015;46:3241-3248.
Desilles JP, Syvannarath V, Di Meglio L, et al. Downstream microvascular thrombosis in cortical venules is an early response to proximal cerebral arterial occlusion. J Am Heart Assoc 2018;7:e007804.
Desilles JP, Syvannarath V, Ollivier V, et al. Exacerbation of Thromboinflammation by hyperglycemia precipitates cerebral infarct growth and hemorrhagic transformation. Stroke 2017;48:1932-1940.
Faizy TD, Mlynash M, Marks MP, et al. Intravenous tPA (tissue-type plasminogen activator) correlates with favorable venous outflow profiles in acute ischemic stroke. Stroke 2022;53:3145-3152.
Lapergue B, Blanc R, Costalat V, et al. Effect of thrombectomy with combined contact aspiration and stent retriever vs stent retriever alone on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER2 randomized clinical trial. JAMA 2021;326:1158-1169.
Roth W, Morgello S, Goldman J, et al. Histopathological differences between the anterior and posterior brain arteries as a function of aging. Stroke 2017;48:638-644.
Etchevers HC, Vincent C, Le Douarin NM, Couly GF. The cephalic neural crest provides pericytes and smooth muscle cells to all blood vessels of the face and forebrain. Development 2001;128:1059-1068.
Le Douarin NM, Kalcheim C. The neural crest. 2nd ed. Cambridge, New York: Cambridge University Press, 1999.
Maier B, Finitsis S, Bourcier R, et al. First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry. J Neurointerv Surg. 2021;14:450-456.
Peschillo S, Diana F, Berge J, Missori P. A comparison of acute vascular damage caused by ADAPT versus a stent retriever device after thrombectomy in acute ischemic stroke: a histological and ultrastructural study in an animal model. J Neurointerv Surg 2017;9:743-749.
Peschillo S, Tomasello A, Diana F, et al. Comparison of subacute vascular damage caused by ADAPT versus stent retriever devices after thrombectomy in acute ischemic stroke: histological and ultrastructural study in an animal model. Interv Neurol 2018;7:501-512.
Gory B, Bresson D, Kessler I, et al. Histopathologic evaluation of arterial wall response to 5 neurovascular mechanical thrombectomy devices in a swine model. AJNR Am J Neuroradiol 2013;34:2192-2198.