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.
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Acknowledgements
We thank all persons who participated in IRETAS and SITS-ISTR.
Funding
The project ‘‘Registro Nazionale Trattamento Ictus Acuto’’ (RFPS-2006-1-336562) was funded by grants from the Italian Ministry of Health within the framework of 2006 Finalized Research Programmes (D.Lgs.n.502/1992). The present study received no funding.
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MC: consultancy or advisory board fees or speaker’s honoraria from Boehringer Ingelheim, Pfizer/Bristol Meyer Squibb, and Daiichi Sankyo. AZ: consultancy and speaker’s honoria fees from Boehringer-Ingelheim, Medtronic, Cerenovus and advisory board from Daiichi Sankyo and Boehringer-Ingelheim and Stryker. LR: speaker’s honoraria from stryker, penumbra. EL: consultancy fees from Stryker. ADV: consultancy from Boehringer Ingelheim, Daichi Sankyo. MB: consultancy fees from Stryker, Penumbra. SC: advisory board fees or speaker’s honoraria from Abbott, Allergan-Abbvie, AstraZeneca, Eli Lilly, Lundbeck, Novartis, NovoNordisk, Pfizer, Teva. All other authors report no conflicts of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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The present study was in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Need for ethical approval or patient consent for participation in the IRETAS varied among participating hospitals. Informed consent to use of anonymized and aggregated data for participation in the IRETAS was obtained in all patients of each center.
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Cappellari, M., Saia, V., Pracucci, G. et al. Stroke with large vessel occlusion in the posterior circulation: IV thrombolysis plus thrombectomy versus IV thrombolysis alone. J Thromb Thrombolysis 56, 454–462 (2023). https://doi.org/10.1007/s11239-023-02844-4
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DOI: https://doi.org/10.1007/s11239-023-02844-4