Stroke with large vessel occlusion in the posterior circulation: IV thrombolysis plus thrombectomy versus IV thrombolysis alone.

Autor: Cappellari M; Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy. manuel_cappellari@libero.it., Saia V; Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy., Pracucci G; Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy., Casetta I; Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy., Fainardi E; Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Firenze, Italy., Sallustio F; Unitá di Trattamento Neurovascolare, ospedale dei Castelli-ASL6, Roma, Italy., Ruggiero M; Neuroradiologia, AUSL Romagna Ospedale Bufalini, Cesena, Italy., Romoli M; Neurologia e Stroke Unit H Bufalini Cesena, AUSL Romagna, Cesena, Italy., Simonetti L; UO Neuroradiologia Ospedale Maggiore, IRCCS Istituto di Scienze Neurologiche di Bologna, Bologna, Italy., Zini A; Department of Neurology and Stroke Center, IRCCS Istituto di Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy., Lazzarotti GA; Department of Neuroradiology, AOU Pisana, Pisa, Italy., Orlandi G; Neurological Institute, University Hospital of Pisa, Italy, Italy., Vallone S; Neuroradiologia, AOU di Modena, Modena, Italy., Bigliardi G; Neurologia-Stroke Unit, AOU di Modena, Modena, Italy., Renieri L; Neurovascular Interventional Unit, Careggi University Hospital, Firenze, Italy., Nencini P; Stroke Unit, Azienda Ospedaliero Univarsitaria Careggi, Firenze, Italy., Semeraro V; Neuroradiology, SS. Annunziata Hospital, Taranto, Italy., Boero G; Neurology, SS. Annunziata Hospital, Taranto, Italy., Bracco S; Neuroradiologia Interventistica, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy., Tassi R; Stroke Unit, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy., Castellano D; S.C. Radiologia e Neuroradiologia, Ospedale San Giovanni Bosco, Torino, Italy., Naldi A; 2 Ospedale San Giovanni Bosco, S.C. Neurologia, Torino, Italy., Biraschi F; Department of Human Neurosciences, Interventional Neuroradiology, Universita degli Studi di Roma Sapienza, Roma, Lazio, Italy., Nicolini E; Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy., Del Sette B; Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy., Malfatto L; Neurology and Stroke Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy., Allegretti L; Department of Neuroradiology, S. Corona Hospital, Pietra Ligure, Italy., Tassinari T; Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy., Tessitore A; Neuroradiology Unit, Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy., Ferraù L; Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Saletti A; Servizio di Neuroradiologia, Arcispedale S. Anna-University Hospital, Ferrara, Italy., De Vito A; Neurology Division-Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy., Lafe E; UOC Radiologia Diagnostica Per Immagini 2, Neuroradiologia, Policlinico IRCCS San Matteo, Pavia, Italy., Cavallini A; UO Neurologia d'Urgenza e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy., Bergui M; Università Torino Dipartimento Neuroscienze, Città della Salute e della Scienza-Molinette, Turin, Italy., Bosco G; Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy., Feraco P; U.O.C. Neuroradiologia Diagnostica e Radiologia Interventistica, Ospedale Santa Chiara, Trento, Italy., Bignamini V; U.O.C Neurologia, Ospedale Santa Chiara, APSS di Trento, Trento, Italy., Mandruzzato N; Neuroradiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Vit F; Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy., Mardighian D; Neuroradiologia, Spedali Civili, Brescia, Italy., Magoni M; Stroke Unit, Spedali Civili, Brescia, Italy., Comelli S; Vascular and Interventional Neuroradiology Department, ARNAS G. Brotzu, Cagliari, Italy., Melis M; Neuroscience Department, ARNAS G. Brotzu, Cagliari, Italy., Menozzi R; Neuroradiologia, Ospedale Universitario, Parma, Italy., Scoditti U; Stroke Unit, Ospedale Universitario, Parma, Italy., Cester G; Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy., Viario F; Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy., Stecco A; Neuroradiology Unit, AOU 'Maggiore della Carità', Novara, Italy., Fleetwood T; Neurology Unit, AOU 'Maggiore della Carità', Novara, Italy., Filauri P; UOSD Radiologia Interventistica, p.o. Avezzano, AQ, Italy., Sacco S; UOC Neurologia e Stroke Unit, p.o. Avezzano, AQ, Italy., Giorgianni A; UOC Neuroradiologia, ASST Sette Laghi Varese, Ospedale di Circolo e Fondazione Macchi, Varese, Italy., Cariddi LP; Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy., Piano M; Interventional Neuroradiology Unit, Ospedale Niguarda, Milano, Italy., Motto C; Stroke Unit-Neurology, Ospedale Niguarda, Milano, Italy., Gallesio I; Neuroradiology Unit AO 'SS. Antonio e Biagio e C. Arrigo', Alessandria, Italy., Sepe F; Neurology Unit AO 'SS. Antonio e Biagio e C. Arrigo', Alessandria, Italy., Romano G; Neuroradiology, ASO Santa Croce e Carle, Cuneo, Italy., Grasso MF; Stroke Unit, ASO Santa Croce e Carle, Cuneo, Italy., Lozupone E; Department of Neuroradiology, Vito Fazzi Hospital, Lecce, Italy., Fasano A; Department of Neurology, Vito Fazzi Hospital, Lecce, Italy., Comai A; Neuroradiologia, Ospedale Provinciale di Bolzano, Bolzano, Italy., Franchini E; Neurologia, Ospedale Provinciale di Bolzano, Bolzano, Italy., Bruni S; Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Silvestrini M; Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Chiumarulo L; UOS Neuroradiologia Interventistica, AOU Consorziale Policlinico, Policlinico Bari, Italy., Petruzzelli M; UOS Stroke Unit, AOU Consorziale Policlinico, Bari, Italy., Pavia M; Neuroradiologia, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy., Invernizzi P; Stroke Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy., Puglielli E; Vascular and Interventional Radiology Unit, Ospedale Civile Mazzini, Teramo, Italy., Casalena A; Neurology Unit, Ospedale Civile Mazzini, Teramo, Italy., Pedicelli A; Dipartimento di Diagnostica per Immagini, UOSA Neuroradiologia Interventistica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy., Frisullo G; Dipartimento Scienze dell'Invecchiamento, Neurologiche, UOC Neurologia, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy., Amistà P; Neuroradiologia, Ospedale S. Maria Misericordia, Rovigo, Italy., Russo M; Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy., Allegritti M; Dipartimento di Diagnostica per Immagini, Azienda Ospedaliera S. Maria Terni Angiografia Diagostica e Terapeutica, Azienda Ospedaliera 'S. Maria', Terni, Italy., Caproni S; Neurologia e Stroke Unit, Dipartimento di Neuroscienze, Azienda Ospedaliera 'S. Maria', Terni, Italy., Mangiafico S; Interventional Neuroradiology Consultant at IRCCS Neuromed, Pozzilli (IS), and Adjunct Professor of Interventional Neuroradiology at Tor Vergata University, Sapienza University and S. Andrea Hospital, Rome, Italy., Toni D; Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy.
Jazyk: angličtina
Zdroj: Journal of thrombosis and thrombolysis [J Thromb Thrombolysis] 2023 Oct; Vol. 56 (3), pp. 454-462. Date of Electronic Publication: 2023 Jun 28.
DOI: 10.1007/s11239-023-02844-4
Abstrakt: 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.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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