Stroke with large vessel occlusion in the posterior circulation: IV thrombolysis plus thrombectomy versus IV thrombolysis alone
Abstract Efficacy and safety of mechanical thrombectomy (MT) for stroke with posterior circulation large vessel occlusion (LVO) is still under debate. We aimed to compare the outcomes of stroke patients with posterior circulation LVO treated with intravenous thrombolysis (IVT) (< 4.5 h after symptom onset) plus MT < 6 h after symptom onset with those treated with IVT alone (< 4.5 h after symptom onset). Patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) and in the Italian centers included in the SITS-ISTR were analysed. We identified 409 IRETAS patients treated with IVT plus MT and 384 SITS-ISTR patients treated with IVT alone. IVT plus MT was significantly associated with higher rate of sICH (ECASS II) compared with IVT alone (3.1 vs 1.9%; OR 3.984, 95% CI 1.014–15.815), while the two treatments did not differ significantly in 3-month mRS score ≤ 3 (64.3 vs 74.1%; OR 0.829, 95% CI 0.524–1.311). In 389 patients with isolated basilar artery (BA) occlusion, IVT plus MT was significantly associated with higher rate of any ICH compared with IVT alone (9.4 vs 7.4%; OR 4.131, 95% CI 1.215–14.040), while two treatments did not differ significantly in 3-month mRS score ≤ 3 and sICH per ECASS II definition. IVT plus MT was significantly associated with higher rate mRS score ≤ 2 (69.1 vs 52.1%; OR 2.692, 95% CI 1.064–6.811) and lower rate of death (13.8 vs 27.1%; OR 0.299, 95% CI 0.095–0.942) in patients with distal-segment BA occlusion, while two treatments did not differ significantly in 3-month mRS score ≤ 3 and sICH per ECASS II definition. IVT plus MT was significantly associated with lower rate of mRS score ≤ 3 (37.1 vs 53.3%; OR 0.137, 0.009–0.987), mRS score ≤ 1 (22.9 vs 53.3%; OR 0.066, 95% CI 0.006–0.764), mRS score ≤ 2 (34.3 vs 53.3%; OR 0.102, 95% CI 0.011–0.935), and higher rate of death (51.4 vs 40%; OR 16.244, 1.395–89.209) in patients with proximal-segment BA occlusion. Compared with IVT alone, IVT plus MT was significantly associated with higher rate of sICH per ECASS II definition in patients with stroke and posterior circulation LVO, while two treatment groups did not differ significantly in 3-month mRS score ≤ 3. IVT plus MT was associated with lower rate of mRS score ≤ 3 compared with IVT alone in patients with proximal-segment BA occlusion, whereas no significant difference was found between the two treatments in primary endpoints in patients isolated BA occlusion and in the other subgroups based on site occlusion..
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:56 |
|---|---|
| Enthalten in: |
Journal of thrombosis and thrombolysis - 56(2023), 3 vom: 28. Juni, Seite 454-462 |
| Sprache: |
Englisch |
|---|
| Links: |
Volltext [lizenzpflichtig] |
|---|
| BKL: | |
|---|---|
| Themen: |
Large vessel occlusion |
| Anmerkungen: |
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
|---|
| doi: |
10.1007/s11239-023-02844-4 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
OLC2145091416 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | OLC2145091416 | ||
| 003 | DE-627 | ||
| 005 | 20240118102705.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240118s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1007/s11239-023-02844-4 |2 doi | |
| 035 | |a (DE-627)OLC2145091416 | ||
| 035 | |a (DE-He213)s11239-023-02844-4-e | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 082 | 0 | 4 | |a 610 |q VZ |
| 084 | |a 44.85$jKardiologie$jAngiologie |2 bkl | ||
| 100 | 1 | |a Cappellari, Manuel |e verfasserin |0 (orcid)0000-0002-3534-3201 |4 aut | |
| 245 | 1 | 0 | |a Stroke with large vessel occlusion in the posterior circulation: IV thrombolysis plus thrombectomy versus IV thrombolysis alone |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. | ||
| 520 | |a Abstract Efficacy and safety of mechanical thrombectomy (MT) for stroke with posterior circulation large vessel occlusion (LVO) is still under debate. We aimed to compare the outcomes of stroke patients with posterior circulation LVO treated with intravenous thrombolysis (IVT) (< 4.5 h after symptom onset) plus MT < 6 h after symptom onset with those treated with IVT alone (< 4.5 h after symptom onset). Patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) and in the Italian centers included in the SITS-ISTR were analysed. We identified 409 IRETAS patients treated with IVT plus MT and 384 SITS-ISTR patients treated with IVT alone. IVT plus MT was significantly associated with higher rate of sICH (ECASS II) compared with IVT alone (3.1 vs 1.9%; OR 3.984, 95% CI 1.014–15.815), while the two treatments did not differ significantly in 3-month mRS score ≤ 3 (64.3 vs 74.1%; OR 0.829, 95% CI 0.524–1.311). In 389 patients with isolated basilar artery (BA) occlusion, IVT plus MT was significantly associated with higher rate of any ICH compared with IVT alone (9.4 vs 7.4%; OR 4.131, 95% CI 1.215–14.040), while two treatments did not differ significantly in 3-month mRS score ≤ 3 and sICH per ECASS II definition. IVT plus MT was significantly associated with higher rate mRS score ≤ 2 (69.1 vs 52.1%; OR 2.692, 95% CI 1.064–6.811) and lower rate of death (13.8 vs 27.1%; OR 0.299, 95% CI 0.095–0.942) in patients with distal-segment BA occlusion, while two treatments did not differ significantly in 3-month mRS score ≤ 3 and sICH per ECASS II definition. IVT plus MT was significantly associated with lower rate of mRS score ≤ 3 (37.1 vs 53.3%; OR 0.137, 0.009–0.987), mRS score ≤ 1 (22.9 vs 53.3%; OR 0.066, 95% CI 0.006–0.764), mRS score ≤ 2 (34.3 vs 53.3%; OR 0.102, 95% CI 0.011–0.935), and higher rate of death (51.4 vs 40%; OR 16.244, 1.395–89.209) in patients with proximal-segment BA occlusion. Compared with IVT alone, IVT plus MT was significantly associated with higher rate of sICH per ECASS II definition in patients with stroke and posterior circulation LVO, while two treatment groups did not differ significantly in 3-month mRS score ≤ 3. IVT plus MT was associated with lower rate of mRS score ≤ 3 compared with IVT alone in patients with proximal-segment BA occlusion, whereas no significant difference was found between the two treatments in primary endpoints in patients isolated BA occlusion and in the other subgroups based on site occlusion. | ||
| 650 | 4 | |a Stroke | |
| 650 | 4 | |a Thrombolysis | |
| 650 | 4 | |a Thrombectomy | |
| 650 | 4 | |a Posterior | |
| 650 | 4 | |a Large vessel occlusion | |
| 700 | 1 | |a Saia, Valentina |4 aut | |
| 700 | 1 | |a Pracucci, Giovanni |4 aut | |
| 700 | 1 | |a Casetta, Ilaria |4 aut | |
| 700 | 1 | |a Fainardi, Enrico |4 aut | |
| 700 | 1 | |a Sallustio, Fabrizio |4 aut | |
| 700 | 1 | |a Ruggiero, Maria |4 aut | |
| 700 | 1 | |a Romoli, Michele |4 aut | |
| 700 | 1 | |a Simonetti, Luigi |4 aut | |
| 700 | 1 | |a Zini, Andrea |4 aut | |
| 700 | 1 | |a Lazzarotti, Guido Andrea |4 aut | |
| 700 | 1 | |a Orlandi, Giovanni |4 aut | |
| 700 | 1 | |a Vallone, Stefano |4 aut | |
| 700 | 1 | |a Bigliardi, Guido |4 aut | |
| 700 | 1 | |a Renieri, Leonardo |4 aut | |
| 700 | 1 | |a Nencini, Patrizia |4 aut | |
| 700 | 1 | |a Semeraro, Vittorio |4 aut | |
| 700 | 1 | |a Boero, Giovanni |4 aut | |
| 700 | 1 | |a Bracco, Sandra |4 aut | |
| 700 | 1 | |a Tassi, Rossana |4 aut | |
| 700 | 1 | |a Castellano, Davide |4 aut | |
| 700 | 1 | |a Naldi, Andrea |4 aut | |
| 700 | 1 | |a Biraschi, Francesco |4 aut | |
| 700 | 1 | |a Nicolini, Ettore |4 aut | |
| 700 | 1 | |a Del Sette, Bruno |4 aut | |
| 700 | 1 | |a Malfatto, Laura |4 aut | |
| 700 | 1 | |a Allegretti, Luca |4 aut | |
| 700 | 1 | |a Tassinari, Tiziana |4 aut | |
| 700 | 1 | |a Tessitore, Agostino |4 aut | |
| 700 | 1 | |a Ferraù, Ludovica |4 aut | |
| 700 | 1 | |a Saletti, Andrea |4 aut | |
| 700 | 1 | |a De Vito, Alessandro |4 aut | |
| 700 | 1 | |a Lafe, Elvis |4 aut | |
| 700 | 1 | |a Cavallini, Anna |4 aut | |
| 700 | 1 | |a Bergui, Mauro |4 aut | |
| 700 | 1 | |a Bosco, Giovanni |4 aut | |
| 700 | 1 | |a Feraco, Paola |4 aut | |
| 700 | 1 | |a Bignamini, Valeria |4 aut | |
| 700 | 1 | |a Mandruzzato, Nicolò |4 aut | |
| 700 | 1 | |a Vit, Federica |4 aut | |
| 700 | 1 | |a Mardighian, Dikran |4 aut | |
| 700 | 1 | |a Magoni, Mauro |4 aut | |
| 700 | 1 | |a Comelli, Simone |4 aut | |
| 700 | 1 | |a Melis, Maurizio |4 aut | |
| 700 | 1 | |a Menozzi, Roberto |4 aut | |
| 700 | 1 | |a Scoditti, Umberto |4 aut | |
| 700 | 1 | |a Cester, Giacomo |4 aut | |
| 700 | 1 | |a Viario, Federica |4 aut | |
| 700 | 1 | |a Stecco, Alessandro |4 aut | |
| 700 | 1 | |a Fleetwood, Thomas |4 aut | |
| 700 | 1 | |a Filauri, Pietro |4 aut | |
| 700 | 1 | |a Sacco, Simona |4 aut | |
| 700 | 1 | |a Giorgianni, Andrea |4 aut | |
| 700 | 1 | |a Cariddi, Lucia Princiotta |4 aut | |
| 700 | 1 | |a Piano, Mariangela |4 aut | |
| 700 | 1 | |a Motto, Cristina |4 aut | |
| 700 | 1 | |a Gallesio, Ivan |4 aut | |
| 700 | 1 | |a Sepe, Federica |4 aut | |
| 700 | 1 | |a Romano, Giuseppe |4 aut | |
| 700 | 1 | |a Grasso, Maria Federica |4 aut | |
| 700 | 1 | |a Lozupone, Emilio |4 aut | |
| 700 | 1 | |a Fasano, Antonio |4 aut | |
| 700 | 1 | |a Comai, Alessio |4 aut | |
| 700 | 1 | |a Franchini, Erica |4 aut | |
| 700 | 1 | |a Bruni, Stefano |4 aut | |
| 700 | 1 | |a Silvestrini, Mauro |4 aut | |
| 700 | 1 | |a Chiumarulo, Luigi |4 aut | |
| 700 | 1 | |a Petruzzelli, Marco |4 aut | |
| 700 | 1 | |a Pavia, Marco |4 aut | |
| 700 | 1 | |a Invernizzi, Paolo |4 aut | |
| 700 | 1 | |a Puglielli, Edoardo |4 aut | |
| 700 | 1 | |a Casalena, Alfonsina |4 aut | |
| 700 | 1 | |a Pedicelli, Alessandro |4 aut | |
| 700 | 1 | |a Frisullo, Giovanni |4 aut | |
| 700 | 1 | |a Amistà, Pietro |4 aut | |
| 700 | 1 | |a Russo, Monia |4 aut | |
| 700 | 1 | |a Allegritti, Massimiliano |4 aut | |
| 700 | 1 | |a Caproni, Stefano |4 aut | |
| 700 | 1 | |a Mangiafico, Salvatore |4 aut | |
| 700 | 1 | |a Toni, Danilo |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of thrombosis and thrombolysis |d Springer US, 1994 |g 56(2023), 3 vom: 28. Juni, Seite 454-462 |h Online-Ressource |w (DE-627)320578445 |w (DE-600)2017305-2 |w (DE-576)107930692 |x 1573-742X |7 nnns |
| 773 | 1 | 8 | |g volume:56 |g year:2023 |g number:3 |g day:28 |g month:06 |g pages:454-462 |
| 856 | 4 | 0 | |u https://dx.doi.org/10.1007/s11239-023-02844-4 |z lizenzpflichtig |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a SYSFLAG_A | ||
| 912 | |a GBV_OLC | ||
| 912 | |a GBV_ILN_11 | ||
| 912 | |a GBV_ILN_20 | ||
| 912 | |a GBV_ILN_22 | ||
| 912 | |a GBV_ILN_23 | ||
| 912 | |a GBV_ILN_24 | ||
| 912 | |a GBV_ILN_31 | ||
| 912 | |a GBV_ILN_32 | ||
| 912 | |a GBV_ILN_39 | ||
| 912 | |a GBV_ILN_40 | ||
| 912 | |a GBV_ILN_60 | ||
| 912 | |a GBV_ILN_62 | ||
| 912 | |a GBV_ILN_63 | ||
| 912 | |a GBV_ILN_69 | ||
| 912 | |a GBV_ILN_70 | ||
| 912 | |a GBV_ILN_73 | ||
| 912 | |a GBV_ILN_74 | ||
| 912 | |a GBV_ILN_90 | ||
| 912 | |a GBV_ILN_95 | ||
| 912 | |a GBV_ILN_100 | ||
| 912 | |a GBV_ILN_101 | ||
| 912 | |a GBV_ILN_105 | ||
| 912 | |a GBV_ILN_110 | ||
| 912 | |a GBV_ILN_120 | ||
| 912 | |a GBV_ILN_138 | ||
| 912 | |a GBV_ILN_150 | ||
| 912 | |a GBV_ILN_151 | ||
| 912 | |a GBV_ILN_152 | ||
| 912 | |a GBV_ILN_161 | ||
| 912 | |a GBV_ILN_170 | ||
| 912 | |a GBV_ILN_171 | ||
| 912 | |a GBV_ILN_187 | ||
| 912 | |a GBV_ILN_213 | ||
| 912 | |a GBV_ILN_224 | ||
| 912 | |a GBV_ILN_230 | ||
| 912 | |a GBV_ILN_250 | ||
| 912 | |a GBV_ILN_281 | ||
| 912 | |a GBV_ILN_285 | ||
| 912 | |a GBV_ILN_293 | ||
| 912 | |a GBV_ILN_370 | ||
| 912 | |a GBV_ILN_602 | ||
| 912 | |a GBV_ILN_636 | ||
| 912 | |a GBV_ILN_702 | ||
| 912 | |a GBV_ILN_711 | ||
| 912 | |a GBV_ILN_2001 | ||
| 912 | |a GBV_ILN_2003 | ||
| 912 | |a GBV_ILN_2004 | ||
| 912 | |a GBV_ILN_2005 | ||
| 912 | |a GBV_ILN_2006 | ||
| 912 | |a GBV_ILN_2007 | ||
| 912 | |a GBV_ILN_2008 | ||
| 912 | |a GBV_ILN_2009 | ||
| 912 | |a GBV_ILN_2010 | ||
| 912 | |a GBV_ILN_2011 | ||
| 912 | |a GBV_ILN_2014 | ||
| 912 | |a GBV_ILN_2015 | ||
| 912 | |a GBV_ILN_2020 | ||
| 912 | |a GBV_ILN_2021 | ||
| 912 | |a GBV_ILN_2025 | ||
| 912 | |a GBV_ILN_2026 | ||
| 912 | |a GBV_ILN_2027 | ||
| 912 | |a GBV_ILN_2031 | ||
| 912 | |a GBV_ILN_2034 | ||
| 912 | |a GBV_ILN_2037 | ||
| 912 | |a GBV_ILN_2038 | ||
| 912 | |a GBV_ILN_2039 | ||
| 912 | |a GBV_ILN_2044 | ||
| 912 | |a GBV_ILN_2048 | ||
| 912 | |a GBV_ILN_2049 | ||
| 912 | |a GBV_ILN_2055 | ||
| 912 | |a GBV_ILN_2057 | ||
| 912 | |a GBV_ILN_2059 | ||
| 912 | |a GBV_ILN_2061 | ||
| 912 | |a GBV_ILN_2064 | ||
| 912 | |a GBV_ILN_2065 | ||
| 912 | |a GBV_ILN_2068 | ||
| 912 | |a GBV_ILN_2088 | ||
| 912 | |a GBV_ILN_2093 | ||
| 912 | |a GBV_ILN_2106 | ||
| 912 | |a GBV_ILN_2107 | ||
| 912 | |a GBV_ILN_2108 | ||
| 912 | |a GBV_ILN_2110 | ||
| 912 | |a GBV_ILN_2111 | ||
| 912 | |a GBV_ILN_2112 | ||
| 912 | |a GBV_ILN_2113 | ||
| 912 | |a GBV_ILN_2118 | ||
| 912 | |a GBV_ILN_2129 | ||
| 912 | |a GBV_ILN_2136 | ||
| 912 | |a GBV_ILN_2143 | ||
| 912 | |a GBV_ILN_2144 | ||
| 912 | |a GBV_ILN_2147 | ||
| 912 | |a GBV_ILN_2148 | ||
| 912 | |a GBV_ILN_2152 | ||
| 912 | |a GBV_ILN_2153 | ||
| 912 | |a GBV_ILN_2188 | ||
| 912 | |a GBV_ILN_2190 | ||
| 912 | |a GBV_ILN_2232 | ||
| 912 | |a GBV_ILN_2336 | ||
| 912 | |a GBV_ILN_2433 | ||
| 912 | |a GBV_ILN_2446 | ||
| 912 | |a GBV_ILN_2470 | ||
| 912 | |a GBV_ILN_2474 | ||
| 912 | |a GBV_ILN_2507 | ||
| 912 | |a GBV_ILN_2522 | ||
| 912 | |a GBV_ILN_2548 | ||
| 912 | |a GBV_ILN_4035 | ||
| 912 | |a GBV_ILN_4037 | ||
| 912 | |a GBV_ILN_4046 | ||
| 912 | |a GBV_ILN_4112 | ||
| 912 | |a GBV_ILN_4125 | ||
| 912 | |a GBV_ILN_4126 | ||
| 912 | |a GBV_ILN_4242 | ||
| 912 | |a GBV_ILN_4246 | ||
| 912 | |a GBV_ILN_4249 | ||
| 912 | |a GBV_ILN_4251 | ||
| 912 | |a GBV_ILN_4305 | ||
| 912 | |a GBV_ILN_4306 | ||
| 912 | |a GBV_ILN_4307 | ||
| 912 | |a GBV_ILN_4313 | ||
| 912 | |a GBV_ILN_4322 | ||
| 912 | |a GBV_ILN_4323 | ||
| 912 | |a GBV_ILN_4324 | ||
| 912 | |a GBV_ILN_4325 | ||
| 912 | |a GBV_ILN_4326 | ||
| 912 | |a GBV_ILN_4328 | ||
| 912 | |a GBV_ILN_4333 | ||
| 912 | |a GBV_ILN_4334 | ||
| 912 | |a GBV_ILN_4335 | ||
| 912 | |a GBV_ILN_4336 | ||
| 912 | |a GBV_ILN_4338 | ||
| 912 | |a GBV_ILN_4393 | ||
| 912 | |a GBV_ILN_4700 | ||
| 936 | b | k | |a 44.85$jKardiologie$jAngiologie |q VZ |0 106409417 |0 (DE-625)106409417 |
| 951 | |a AR | ||
| 952 | |d 56 |j 2023 |e 3 |b 28 |c 06 |h 454-462 | ||