Background and aims: The best reperfusion treatment for patients with mild acute ischemic stroke (AIS) harboring proximal anterior circulation large vessel occlusion (LVO) is unknown. We aimed to compare the safety and efficacy of intravenous thrombolysis (IVT) plus endovascular thrombectomy (EVT) vs IVT alone in LVO patients with mild symptoms. Methods: From the SITS-International Stroke Thrombolysis and Thrombectomy Register (SITS-ISTR), we included consecutive treated AIS patients presenting within 4.5h, with NIHSS score ≤5 and intracranial ICA, M1 or T occlusion. After propensity score matching (PSM), we compared (via univariable and multivariable logistic [and ordinal] regression analyses) 3-month functional outcomes (modified Rankin Scale [mRS] 0-1 and 0-2) and safety outcomes (symptomatic intracerebral hemorrhage [SICH] and death) in patients treated with IVT+EVT vs IVT alone. Results: 1037 patients were included. After PSM (n=312 per group), IVT+EVT was independently associated with poor functional outcomes (aOR 0.46 for mRS 0-1 [95%CI 0.30-0.72], p=0.001; aOR 0.52 for mRS 0-2 [95%CI 0.32-0.84], p=0.007; aOR 1.61 for 1-point shift in mRS score [95%CI 1.12-2.32; p=0.011]), with no significant differences in safety outcomes compared to IVT alone - despite numerically higher rates of SICH (3.3% vs 1.1%; p=0.082), higher rate of any hemorrhagic transformation (17.6% vs 7.3%; p<0.001) and subarachnoid hemorrhage (SAH; 7.9% vs 1.5%; p=0.002) in IVT+EVT group. Discussion: In anterior circulation LVO patients presenting with NIHSS score ≤5, IVT+EVT (vs. IVT alone) was associated with poorer 3-month functional outcome. Randomized-controlled trials are needed to elucidate the best treatments in mild LVO patients.
Intravenous thrombolysis + endovascular thrombectomy versus thrombolysis alone in large vessel occlusion mild stroke: a propensity score matched analysis
Mancuso, Michelangelo;
2023-01-01
Abstract
Background and aims: The best reperfusion treatment for patients with mild acute ischemic stroke (AIS) harboring proximal anterior circulation large vessel occlusion (LVO) is unknown. We aimed to compare the safety and efficacy of intravenous thrombolysis (IVT) plus endovascular thrombectomy (EVT) vs IVT alone in LVO patients with mild symptoms. Methods: From the SITS-International Stroke Thrombolysis and Thrombectomy Register (SITS-ISTR), we included consecutive treated AIS patients presenting within 4.5h, with NIHSS score ≤5 and intracranial ICA, M1 or T occlusion. After propensity score matching (PSM), we compared (via univariable and multivariable logistic [and ordinal] regression analyses) 3-month functional outcomes (modified Rankin Scale [mRS] 0-1 and 0-2) and safety outcomes (symptomatic intracerebral hemorrhage [SICH] and death) in patients treated with IVT+EVT vs IVT alone. Results: 1037 patients were included. After PSM (n=312 per group), IVT+EVT was independently associated with poor functional outcomes (aOR 0.46 for mRS 0-1 [95%CI 0.30-0.72], p=0.001; aOR 0.52 for mRS 0-2 [95%CI 0.32-0.84], p=0.007; aOR 1.61 for 1-point shift in mRS score [95%CI 1.12-2.32; p=0.011]), with no significant differences in safety outcomes compared to IVT alone - despite numerically higher rates of SICH (3.3% vs 1.1%; p=0.082), higher rate of any hemorrhagic transformation (17.6% vs 7.3%; p<0.001) and subarachnoid hemorrhage (SAH; 7.9% vs 1.5%; p=0.002) in IVT+EVT group. Discussion: In anterior circulation LVO patients presenting with NIHSS score ≤5, IVT+EVT (vs. IVT alone) was associated with poorer 3-month functional outcome. Randomized-controlled trials are needed to elucidate the best treatments in mild LVO patients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
