Aspiration Versus Stent Retriever Thrombectomy for Posterior Circulation Stroke
| Autor: | Robert J. van Oostenbrugge, Robert-Jan B. Goldhoorn, Agnetha A E Bruggeman, Wim H. van Zwam, Marie Louise E. Bernsen, Jonathan M. Coutinho, Wouter J. Schonewille, Bart J. Emmer, Josje Brouwer, Jasper M. Martens, Charles B. L. M. Majoie, Christiaan van der Leij, Jeannette Hofmeijer |
|---|---|
| Přispěvatelé: | TechMed Centre, Clinical Neurophysiology, Radiology and nuclear medicine, ACS - Atherosclerosis & ischemic syndromes, Radiology and Nuclear Medicine, Graduate School, ACS - Microcirculation, Amsterdam Neuroscience - Brain Imaging, Amsterdam Neuroscience - Neurovascular Disorders, Neurology, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), MUMC+: MA AIOS Neurologie (9), Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Neurologie (3), Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B06 Imaging |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Suction (medicine)
Male medicine.medical_specialty law.invention Randomized controlled trial law medicine Humans Circulation (currency) Prospective Studies cardiovascular diseases Endovascular treatment Stroke Stent retriever Aged Ischemic Stroke Netherlands Advanced and Specialized Nursing OUTCOMES suction business.industry BASILAR ARTERY-OCCLUSION endovascular procedure Endovascular Procedures registries Middle Aged medicine.disease OPEN-LABEL stroke Surgery reperfusion ISCHEMIC-STROKE thrombectomy Female Neurology (clinical) Cardiology and Cardiovascular Medicine business |
| Zdroj: | Stroke, 53(3), 749-757. Lippincott Williams and Wilkins MR CLEAN Registry Investigators 2022, ' Aspiration Versus Stent Retriever Thrombectomy for Posterior Circulation Stroke ', Stroke, vol. 29, no. 2, pp. 749-757 . https://doi.org/10.1161/STROKEAHA.121.034926 Stroke, 29(2), 749-757. Lippincott Williams and Wilkins Stroke, 29(2). LIPPINCOTT WILLIAMS & WILKINS Stroke, 53(3), 749-757. LIPPINCOTT WILLIAMS & WILKINS |
| ISSN: | 0039-2499 |
| Popis: | Background and Purpose: Whereas a clear benefit of endovascular treatment for anterior circulation stroke has been established, randomized trials assessing the posterior circulation have failed to show efficacy. Previous studies in anterior circulation stroke suggest that advanced thrombectomy devices were of great importance in achieving clinical benefit. Little is known about the effect of thrombectomy techniques on outcomes in posterior circulation stroke. In this study, we compare first-line strategy of direct aspiration to stent retriever thrombectomy for posterior circulation stroke. Methods: We analyzed data of patients with a posterior circulation stroke who were included in the Multicentre Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry between March 2014 and December 2018, a prospective, nationwide study, in which data were collected from consecutive patients who underwent endovascular treatment for ischemic stroke in the Netherlands. We compared patients who underwent first-line aspiration versus stent retriever thrombectomy. Primary outcome was functional outcome according to the modified Rankin Scale. Secondary outcomes were reperfusion grade, complication rate, and procedure duration. Associations between thrombectomy technique and outcome measures were estimated with multivariable ordinal logistic regression analyses. Results: Overall, 71 of 205 patients (35%) were treated with aspiration, and 134 (65%) with stent retriever thrombectomy. Patients in the aspiration group had a lower pc-ASPECTS on baseline computed tomography, and general anesthesia was more often applied in this group. First-line aspiration was associated with better functional outcome compared with stent retriever thrombectomy (adjusted common odds ratio for a 1-point improvement on the modified Rankin Scale 1.94 [95% CI, 1.03–3.65]). Successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2B) was achieved more often with aspiration (87% versus 73%, P =0.03). Symptomatic hemorrhage rates were comparable (3% versus 4%). Procedure times were shorter in the aspiration group (49 versus 69 minutes P Conclusions: In this retrospective nonrandomized cohort study, our findings suggest that first-line aspiration is associated with a shorter procedure time, better reperfusion, and better clinical outcome than stent retriever thrombectomy in patients with ischemic stroke based on large vessel occlusion in the posterior circulation. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|