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.
2023
Schwarz, Ghil; Bonato, Sara; Lanfranconi, Silvia; Matusevicius, Marius; Ghione, Isabella; Valcamonica, Gloria; Tsivgoulis, Georgios; Paiva Nunes, Ana; Mancuso, Michelangelo; Zini, Andrea; Candelaresi, Paolo; Rand, Viiu-Marika; Comi, Giacomo P; Mazya, Michael V; Ahmed, Niaz
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1167586
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? 2
  • Scopus 5
  • ???jsp.display-item.citation.isi??? 5
social impact