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Reperfusion strategies in stroke with medium-to-distal vessel occlusion: a prospective observational study

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Abstract

Introduction

Medium vessel occlusion (MeVO) accounts for 30% of acute ischemic stroke cases. The risk/benefit profile of endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) or the combination of the two (bridging therapy (BT)) is still unclear in MeVO. Here, we compare reperfusion strategies in MeVO for clinical and radiological outcomes.

Methods

This prospective single center study enrolled consecutive patients with AIS due to primary MeVO undergoing IVT, EVT, or BT at a comprehensive stroke center. Primary outcome was good functional status, defined as modified Rankin Scale (mRS) 0–2 at 3-month follow-up. Additional outcomes included mortality, successful recanalization, defined as mTICI ≥ 2b, stroke severity at discharge, and symptomatic intracerebral hemorrhage (sICH) according to SITS-MOST criteria. Logistic regression was modeled to define independent predictors of the primary outcome.

Results

Overall, 180 consecutive people were enrolled (IVT = 59, EVT = 38, BT = 83), mean age 75. BT emerged as independent predictor of primary outcome (OR = 2.76, 95% CI = 1.08–7.07) together with age (OR = 0.94, 95% CI = 0.9–0.97) and baseline NIHSS (OR = 0.88, 95% CI = 0.81–0.95). BT associated with a 20% relative increase in successful recanalization compared to EVT (74.4 vs 56.4%, p = 0.049). Rates of sICH (1.1%) and procedural complications (vasospasm 4.1%, SAH in 1.7%) were very low, with no difference across groups.

Discussion

BT may carry a higher chance of good functional outcome compared to EVT/IVT only in people with AIS due to MeVO, with marginally higher rates of successful recanalization. Randomized trials are needed to define optimal treatment tailoring for MeVO.

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Author notes

  1. Federica Rizzo and Michele Romoli contributed equally to this work.

Authors and Affiliations

  1. Stroke Unit, Vall d’Hebron Hospital and Vall d’Hebron Institut de Recerca, Barcelona, Spain

    Federica Rizzo

  2. Neurology and Stroke Unit, Dept. of Neuroscience, Bufalini Hospital, AUSL Romagna, Cesena, Italy

    Michele Romoli

  3. IRCCS Istituto Delle Scienze Neurologiche Di Bologna, UO Neuroradiologia, Ospedale Maggiore, Bologna, Italy

    Luigi Simonetti, Simone Galluzzo, Francesco Taglialatela & Ciro Princiotta

  4. Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neurologia E Rete Stroke Metropolitana, Ospedale Maggiore, Largo Nigrisoli 2, 40133, Bologna, Italy

    Mauro Gentile, Stefano Forlivesi, Laura Piccolo, Federica Naldi, Matteo Paolucci, Ludovica Migliaccio & Andrea Zini

  5. Department of Neurology and Stroke Unit, AOU Consorziale Policlinico, Bari, Italy

    Marco Petruzzellis

  6. Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari ‘Aldo Moro’, Bari, Italy

    Giancarlo Logroscino

Authors
  1. Federica Rizzo
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  2. Michele Romoli
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  3. Luigi Simonetti
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  4. Mauro Gentile
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  5. Stefano Forlivesi
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  6. Laura Piccolo
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  7. Federica Naldi
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  8. Matteo Paolucci
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  9. Simone Galluzzo
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  10. Francesco Taglialatela
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  11. Ciro Princiotta
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  12. Ludovica Migliaccio
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  13. Marco Petruzzellis
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  14. Giancarlo Logroscino
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  15. Andrea Zini
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Contributions

FR: study design, data collection, and manuscript drafting. MR: study design, manuscript drafting, and statistical analysis. MP, GL, and AZ: study design supervision, and revised manuscript for intellectual content. MG, SF, LP, FN, MP, SG, FT, CP, and LM: revised manuscript for intellectual content.

Corresponding author

Correspondence to Andrea Zini.

Ethics declarations

Ethical approval

Ethical approval was not sought for the present study because the study was nested within the local stroke registry.

Competing interests

The authors declare no competing interests. Relevant disclosures outside the submitted work: AZ declares consulting fees from Boehringer-Ingelheim, Alexion, and CLS Behring and declares grant from the Italian Ministry of Health as principal investigator for clinical trial (RF-2019–12370834). DT reports fees for advisory board and speaker honoraria from Abbott, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Medtronic, and Pfizer.

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Rizzo, F., Romoli, M., Simonetti, L. et al. Reperfusion strategies in stroke with medium-to-distal vessel occlusion: a prospective observational study. Neurol Sci 45, 1129–1134 (2024). https://doi.org/10.1007/s10072-023-07089-w

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  • DOI: https://doi.org/10.1007/s10072-023-07089-w

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