Effect of Deferoxamine on Outcome According to Baseline Hematoma Volume: A Post Hoc Analysis of the i-DEF Trial

Stroke ◽  
2021 ◽  
Author(s):  
Chenchen Wei ◽  
Jeffrey Wang ◽  
Lydia D. Foster ◽  
Sharon D. Yeatts ◽  
Claudia Moy ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Scale Score ◽  
Treatment Effect ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Favorable Outcome ◽  
Modified Rankin Scale ◽  
Hematoma Volume ◽  
Post Hoc Analysis ◽  
Post Hoc

Background and Purpose: Hematoma volume (HV) is a powerful determinant of outcome after intracerebral hemorrhage. We examined whether the effect of the iron chelator, deferoxamine, on functional outcome varied depending on HV in the i-DEF trial (Intracerebral Hemorrhage Deferoxamine). Methods: A post hoc analysis of the i-DEF trial; participants were classified according to baseline HV (small <10 mL, moderate 10–30 mL, and large >30 mL). Favorable outcome was defined as a modified Rankin Scale score of 0–2 at day-180; secondarily at day-90. Logistic regression was used to evaluate the differential treatment effect according to HV. Results: Two hundred ninety-one subjects were included in the as-treated analysis; 121 with small, 114 moderate, and 56 large HV. Day-180 modified Rankin Scale scores were available for 270/291 subjects (111 with small, 105 moderate, and 54 large HV). There was a differential effect of treatment according to HV on day-180 outcomes ( P -for-interaction =0.0077); 50% (27/54) of deferoxamine-treated patients with moderate HV had favorable outcome compared with 25.5% (13/51) of placebo-treated subjects (adjusted odds ratio, 2.7 [95% CI, 1.13–6.27]; P =0.0258). Treatment effect was not significant for small (adjusted odds ratio, 1.37 [95% CI, 0.62–3.02]) or large (adjusted odds ratio, 0.12 [95% CI, 0.01–1.05]) HV. Results for day-90 outcomes were comparable ( P -for-interaction =0.0617). Sensitivity analyses yielded similar results. Conclusions: Among patients with moderate HV, a greater proportion of deferoxamine- than placebo-treated patients achieved modified Rankin Scale score 0–2. The treatment effect was not significant for small or large HVs. These findings have important trial design and therapeutic implications. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02175225.

scholarly journals Endovascular Therapy of Anterior Circulation Tandem Occlusions: Pooled Analysis From the TITAN and ETIS Registries

Stroke ◽  
2021 ◽  
Author(s):  
Mohammad Anadani ◽  
Gaultier Marnat ◽  
Arturo Consoli ◽  
Panagiotis Papanagiotou ◽  
Raul G. Nogueira ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Endovascular Therapy ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Favorable Outcome ◽  
Modified Rankin Scale ◽  
Stent Group ◽  
Anterior Circulation ◽  
Tandem Occlusion

Background and Purpose: Endovascular therapy for tandem occlusion strokes of the anterior circulation is an effective and safe treatment. The best treatment approach for the cervical internal carotid artery (ICA) lesion is still unknown. In this study, we aimed to compare the functional and safety outcomes between different treatment approaches for the cervical ICA lesion during endovascular therapy for acute ischemic strokes due to tandem occlusion in current clinical practice. Methods: Individual patients’ data were pooled from the French prospective multicenter observational ETIS (Endovascular Treatment in Ischemic Stroke) and the international TITAN (Thrombectomy in Tandem Lesions) registries. TITAN enrolled patients from January 2012 to September 2016, and ETIS from January 2013 to July 2019. Patients with acute ischemic stroke due to anterior circulation tandem occlusion who were treated with endovascular therapy were included. Patients were divided based on the cervical ICA lesion treatment into stent and no-stent groups. Outcomes were compared between the two treatment groups using propensity score methods. Results: A total of 603 patients were included, of whom 341 were treated with acute cervical ICA stenting. In unadjusted analysis, the stent group had higher rate of favorable outcome (90-day modified Rankin Scale score, 0–2; 57% versus 45%) and excellent outcome (90-day modified Rankin Scale score, 0–1; 40% versus 27%) compared with the no-stent group. In inverse probability of treatment weighting propensity score–adjusted analyses, stent group had higher odds of favorable outcome (adjusted odds ratio, 1.09 [95% CI, 1.01–1.19]; P =0.036) and successful reperfusion (modified Thrombolysis in Cerebral Ischemia score, 2b-3; adjusted odds ratio, 1.19 [95% CI, 1.11–1.27]; P <0.001). However, stent group had higher odds of any intracerebral hemorrhage (adjusted odds ratio, 1.10 [95%, 1.02–1.19]; P =0.017) but not higher rate of symptomatic intracerebral hemorrhage or parenchymal hemorrhage type 2. Subgroup analysis demonstrated heterogeneity according to the lesion type (atherosclerosis versus dissection; P for heterogeneity, 0.01), and the benefit from acute carotid stenting was only observed for patients with atherosclerosis. Conclusions: Patients treated with acute cervical ICA stenting for tandem occlusion strokes had higher odds of 90-day favorable outcome, despite higher odds of intracerebral hemorrhage; however, most of the intracerebral hemorrhages were asymptomatic.

scholarly journals Treatment and Outcome in Stroke Patients With Acute M2 Occlusion and Minor Neurological Deficits

Stroke ◽  
2021 ◽  
Author(s):  
Tomas Dobrocky ◽  
Eike I. Piechowiak ◽  
Bastian Volbers ◽  
Nedelina Slavova ◽  
Johannes Kaesmacher ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Scale Score ◽  
Cerebral Artery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
National Institutes Of Health ◽  
Neurological Deficits ◽  
Minor Stroke ◽  
Modified Rankin Scale ◽  
Stroke Patients

Background and Purpose: Treatment in stroke patients with M2 segment occlusion of the middle cerebral artery presenting with mild neurological deficits is a matter of debate. The main purpose was to compare the outcome in patients with a minor stroke and a M2 occlusion. Methods: Consecutive intravenous thrombolysis (IVT) eligible patients admitted to the Bernese stroke center between January 2005 and January 2020 with acute occlusion of the M2 segment and National Institutes of Health Stroke Scale score ≤5 were included. Outcome was compared between IVT only versus endovascular therapy (EVT) including intra-arterial thrombolysis and mechanical thrombectomy (MT; ±IVT) and between IVT only versus MT only. Results: Among 169 patients (38.5% women, median age 70.2 years), 84 (49.7%) received IVT only and 85 (50.3%) EVT (±IVT), the latter including 39 (45.9%) treated with MT only. Groups were similar in sex, age, vascular risk factors, event cause, or preevent independency. Compared with IVT only, there was no difference in favorable outcome (modified Rankin Scale score, 0−2) for EVT (adjusted odds ratio, 0.96; adjusted P =0.935) or for MT only (adjusted odds ratio, 1.12; adjusted P =0.547) groups. Considering only patients treated after 2015, there was a significantly better 3-month modified Rankin Scale shift (adjusted P =0.032) in the EVT compared with the IVT only group. Conclusions: Our study demonstrates similar effectiveness of IVT only versus EVT (±IVT), and of IVT only versus MT only in patients with peripheral middle cerebral artery occlusions and minor neurological deficits and indicates a possible benefit of EVT considering only patients treated after 2015. There is an unmet need for randomized controlled trials in this stroke field, including imaging parameters, and more sophisticated evaluation of National Institutes of Health Stroke Scale score subitems, neurocognition, and quality of life neglected by the standard outcome scales such as modified Rankin Scale and National Institutes of Health Stroke Scale score.

scholarly journals Switching to Tenecteplase for Stroke Thrombolysis: Real-World Experience and Outcomes in a Regional Stroke Network

Stroke ◽  
2021 ◽  
Author(s):  
Karim Mahawish ◽  
John Gommans ◽  
Timothy Kleinig ◽  
Bhavesh Lallu ◽  
Alicia Tyson ◽  
...  
Keyword(s):  
Scale Score ◽  
Real World ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Local Population ◽  
Safety Data ◽  
Interquartile Range ◽  
Patient Treatment ◽  
Modified Rankin Scale ◽  
Stroke Thrombolysis

Background and Purpose: Due to practical advantages, increasing trial safety data, recent Australian Guideline endorsement and local population needs we switched to tenecteplase for stroke thrombolysis from alteplase. We describe our change process and real-world outcome data. Methods: Mixed-methods including stakeholder engagement, preimplementation and postimplementation surveys, and assessment of patient treatment rates, metrics, and clinical outcomes preimplementation and postimplementation adjusting regression analyses for age, sex, National Institutes of Health Stroke Scale, premorbid modified Rankin Scale score, and thrombectomy using New Zealand National Stroke Registry data. Results: Preswitch consultation involved stroke and emergency clinicians, pharmacists, national regulatory bodies, and hospital legal teams. All survey responders (90% response rate) supported the proposed change and remained satisfied 12 months postimplementation. Between January 2018 and February 2021, we treated 555 patients with alteplase and 283 with tenecteplase. Patients treated with tenecteplase had greater odds of a favorable modified Rankin Scale using both shift (adjusted odds ratio, 1.60 [95% CI, 1.15–2.22]) and dichotomous analyses (modified Rankin Scale score, 0–2; adjusted odds ratio, 2.17 [95% CI, 1.31–3.59]) and shorter median (interquartile range) door-to-needle time (median, 53 [38–73.5] versus 61 minutes [45–85], P =0.0002). Symptomatic intracranial hemorrhage rates (tenecteplase 1.8% versus 3.4%; adjusted odds ratio, 0.46 [95% CI, 0.13–1.64]), death by day 7 (tenecteplase 7.5% versus 11.8%; adjusted odds ratio, 0.46 [95% CI, 0.21–0.99]), and median (interquartile range) needle to groin time for the 42 transferred regional patients (tenecteplase 155 [113–248] versus 200 [158–266]; P =0.27) did not significantly differ. Conclusions: Following stakeholder endorsement, a region-wide switch from alteplase to tenecteplase was successfully implemented. We found evidence of benefit and no evidence of harm.

Effect of Moderate and Severe Persistent Hyperglycemia on Outcomes in Patients With Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Wei Huang ◽  
Iryna Lobanova ◽  
Premkumar N. Chandrasekaran ◽  
Daniel F. Hanley ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Scale Score ◽  
Odds Ratio ◽  
Serum Glucose ◽  
Hematoma Volume ◽  
Unique Identifier ◽  
Glucose Levels ◽  
Risk Of Death ◽  
The Relationship ◽  
Persistent Hyperglycemia

Background and Purpose: We evaluated the effect of persistent hyperglycemia on outcomes in 1000 patients with intracerebral hemorrhage enrolled within 4.5 hours of symptom onset. Methods: We defined moderate and severe hyperglycemia based on serum glucose levels ≥140 mg/dL—<180 and ≥180 mg/dL, respectively, measured at baseline, 24, 48, and 72 hours. Persistent hyperglycemia was defined by 2 consecutive (24 hours apart) serum glucose levels. We evaluated the relationship between moderate and severe hyperglycemia and death or disability (defined by modified Rankin Scale score of 4–6) at 90 days in the overall cohort and in groups defined by preexisting diabetes. Results: In the multivariate analysis, both moderate (odds ratio, 1.8 [95% CI, 1.1–2.8]) and severe (odds ratio, 1.8 [95% CI, 1.2–2.7]) hyperglycemia were associated with higher 90-day death or disability after adjusting for Glasgow Coma Scale score, hematoma volume, presence or absence of intraventricular hemorrhage, hyperlipidemia, cigarette smoking, and hypertension (no interaction between hyperglycemia and preexisting diabetes, P =0.996). Among the patients without preexisting diabetes, both moderate (odds ratio, 1.8 [95% CI, 1.0–3.2]) and severe (odds ratio, 2.0 [95% CI, 1.1–3.7]) hyperglycemia were associated with 90-day death or disability after adjusting for above mentioned potential confounders. Among the patients with preexisting diabetes, moderate and severe hyperglycemia were not associated with 90-day death or disability. Conclusions: Persistent hyperglycemia, either moderate or severe, increased the risk of death or disability in nondiabetic patients with intracerebral hemorrhage. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01176565.

scholarly journals Prevalence and Outcomes of Medium Vessel Occlusions With Discrepant Infarct Patterns

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
pp. 2817-2824
Author(s):  
Johanna M. Ospel ◽  
Petra Cimflova ◽  
Martha Marko ◽  
Arnuv Mayank ◽  
Moiz Hafeez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Cerebral Artery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Modified Rankin Scale ◽  
Excellent Outcome ◽  
Good Outcome

Background and Purpose: The prognosis of medium vessel occlusions (MeVOs), that is, M2/3 middle cerebral artery, A2/3 anterior cerebral artery, and P2/3 posterior cerebral artery occlusions, is generally better compared with large vessel occlusions, since brain ischemia is less extensive. However, in some MeVO patients, infarcts are seen outside the territory of the occluded vessel (MeVO with discrepant infarcts). This study aims to determine the prevalence and clinical impact of discrepant infarct patterns in acute ischemic stroke due to MeVO. Methods: We pooled data of MeVO patients from INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) and PRove-IT (Precise and Rapid Assessment of Collaterals Using Multi-Phase CTA in the Triage of Patients With Acute Ischemic Stroke for IA Therapy)—2 prospective cohort studies of patients with acute ischemic stroke. The combination of occlusion location on baseline computed tomography angiography and infarct location on follow-up computed tomography/magnetic resonance imaging was used to identify MeVOs with discrepant infarct patterns. Two definitions for discrepant infarcts were applied; one was more restrictive and purely based on infarct patterns of the basal ganglia, whereas the second one took cortical infarct patterns into account. Clinical outcomes of patients with versus without discrepant infarcts were summarized using descriptive statistics. Logistic regression was performed to obtain adjusted effect size estimates for the association of discrepant infarcts and good outcome, defined as a modified Rankin Scale score of 0 to 2, and excellent outcome (modified Rankin Scale score 0–1). Results: Two hundred sixty-two patients with MeVO were included in the analysis. The prevalence of discrepant infarcts was 39.7% (definition 1) and 21.0% (definition 2). Patients with discrepant infarcts were less likely to achieve good outcome (definition 1: adjusted odds ratio, 0.48 [95% CI, 0.25–0.91]; definition 2: adjusted odds ratio, 0.47 [95% CI, 0.22–0.99]). When definition 1 was applied, patients with discrepant infarcts were also less likely to achieve excellent outcome (definition 1: adjusted odds ratio, 0.55 [95% CI, 0.31–0.99]; definition 2: adjusted odds ratio, 0.62 [95% CI, 0.31–1.25]). Conclusions: MeVO patients with discrepant infarcts are common, and they are associated with more severe deficits and poor outcomes.

Outcome after stroke thrombolysis in patients >80 years treated within 3 hours vs >3–4.5 hours

Neurology ◽  
2017 ◽  
Vol 89 (15) ◽  
pp. 1561-1568 ◽  
Author(s):  
Niaz Ahmed ◽  
Kennedy R. Lees ◽  
Peter A. Ringleb ◽  
Christopher Bladin ◽  
David Collas ◽  
...  
Keyword(s):  
Scale Score ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Time Window ◽  
Functional Independence ◽  
Absolute Difference ◽  
Modified Rankin Scale ◽  
Treatment Groups ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Thrombolysis

Objective:To determine outcomes and risks of IV thrombolysis (IVT) in patients with acute ischemic stroke (AIS) >80 years of age within 3 hours compared to >3 to 4.5 hours recorded in the Safe Implementation of Treatment in Stroke (SITS) International Stroke Thrombolysis Registry.Methods:A total of 14,240 (year 2003–2015) patients >80 years of age with AIS were treated with IVT ≤4.5 hours of stroke onset (3,558 in >3–4.5 hours). Of these, 8,658 (2,157 in >3–4.5 hours) were treated otherwise according to the European Summary of Product Characteristics (EU SmPC) criteria for alteplase. Outcomes were 3-month functional independence (modified Rankin Scale score 0–2), mortality, and symptomatic intracerebral hemorrhage (SICH)/SITS. Results were compared between the groups treated in >3 to 4.5 and ≤3 hours.Results:Median age was 84 years; 61% were female in both groups. Median NIH Stroke Scale score was 12 vs 14 in the >3- to 4.5- and ≤3-hour group, respectively. Three-month functional independence was 34% vs 35% (adjusted odds ratio [aOR] 0.78, 95% confidence interval [CI] 0.69–0.89, p < 0.001); mortality was 31% vs 32% (aOR 1.10, 95% CI 0.97–1.25, p = 0.13); and SICH/SITS was 2.7% vs 1.6% (aOR 1.72, 95% CI 1.25–2.35, p = 0.001). In EU SmPC–compliant patients, 3-month functional independence was 36 vs 37% (aOR 0.79, 95% CI 0.68–0.92, p = 0.002), mortality was 29% vs 29.6% (aOR 1.10, 95% CI 0.95–1.28, p = 0.20), and SICH/SITS was 2.7% vs 1.6% (aOR 1.62, 95% CI 1.12–2.34, p = 0.01).Conclusions:In this observational study, unselected patients >80 years of age treated with IVT after 3 hours vs earlier had a slightly higher rate of SICH and similar unadjusted functional outcome but poorer adjusted outcome. The absolute difference between the treatment groups is small, and elderly patients should not be denied IVT in the later time window solely because of age without other contraindications.

Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Lukas Meyer ◽  
Matthias Bechstein ◽  
Maxim Bester ◽  
Uta Hanning ◽  
Caspar Brekenfeld ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cerebral Infarction ◽  
Medical Treatment ◽  
Scale Score ◽  
Odds Ratio ◽  
Modified Rankin Scale ◽  
Anterior Circulation ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Best Medical Treatment ◽  
Increased Risk

Background and Purpose: This study evaluates the benefit of endovascular treatment (EVT) for patients with extensive baseline stroke compared with best medical treatment. Methods: This retrospective, multicenter study compares EVT and best medical treatment for computed tomography (CT)–based selection of patients with extensive baseline infarcts (Alberta Stroke Program Early CT Score ≤5) attributed to anterior circulation stroke. Patients were selected from the German Stroke Registry and 3 tertiary stroke centers. Primary functional end points were rates of good (modified Rankin Scale score of ≤3) and very poor outcome (modified Rankin Scale score of ≥5) at 90 days. Secondary safety end point was the occurrence of symptomatic intracerebral hemorrhage. Angiographic outcome was evaluated with the modified Thrombolysis in Cerebral Infarction Scale. Results: After 1:1 pair matching, a total of 248 patients were compared by treatment arm. Good functional outcome was observed in 27.4% in the EVT group, and in 25% in the best medical treatment group ( P =0.665). Advanced age (adjusted odds ratio, 1.08 [95% CI, 1.05–1.10], P <0.001) and symptomatic intracerebral hemorrhage (adjusted odds ratio, 6.35 [95% CI, 2.08–19.35], P <0.001) were independently associated with very poor outcome. Mortality (43.5% versus 28.9%, P =0.025) and symptomatic intracerebral hemorrhage (16.1% versus 5.6%, P =0.008) were significantly higher in the EVT group. The lowest rates of good functional outcome (≈15%) were observed in groups of failed and partial recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 0/1–2a), whereas patients with complete recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 3) with recanalization attempts ≤2 benefitted the most (modified Rankin Scale score of ≤3:42.3%, P =0.074) compared with best medical treatment. Conclusions: In daily clinical practice, EVT for CT–based selected patients with low Alberta Stroke Program Early CT Score anterior circulation stroke may not be beneficial and is associated with increased risk for hemorrhage and mortality, especially in the elderly. However, first- or second-pass complete recanalization seems to reveal a clinical benefit of EVT highlighting the vulnerability of the low Alberta Stroke Program Early CT Score subgroup. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03356392.

scholarly journals Lack of Reperfusion Rather Than Number of Passes Defines Futility in Stroke Thrombectomy: A Matched Case-Control Study

Stroke ◽  
2021 ◽  
Author(s):  
Mahmoud H. Mohammaden ◽  
Diogo C. Haussen ◽  
Leonardo Pisani ◽  
Alhamza R. Al-Bayati ◽  
Nicolas Bianchi ◽  
...  
Keyword(s):  
Scale Score ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Modified Rankin Scale ◽  
Score Distribution ◽  
Matched Group ◽  
Degree Of Disability ◽  
Number Of Passes

Background and Purpose: There is a robust relationship between the duration of ischemia and functional outcomes after mechanical thrombectomy. Higher number of mechanical thrombectomy passes strongly correlate with lower chances of favorable outcomes. Indeed, previous studies have suggested that after multiple passes the procedure may be futile. However, using uncontrolled thresholds to define thrombectomy futility might be misleading. We aim to compare the outcome of successful reperfusion after 4 to 5 passes and ≥6 passes with those of failed reperfusion. Methods: A prospectively acquired mechanical thrombectomy database from January 2012 to October 2019 was reviewed. Patients were included if they had intracranial internal carotid artery or middle cerebral artery-M1/M2 occlusions and either achieved successful reperfusion after ≥4 passes or failed reperfusion. Reperfused patients (mTICI2b-3) were divided into 2 subgroups; (1) 4 to 5 passes and (2) ≥6 passes. Each subgroup was compared with a matched group of mechanical thrombectomy failure (mTICI0-2a). The primary outcome was the shift in the degree of disability at 90-day as measured by the modified Rankin Scale. Results: A total of 273 patients were included. As compared with matched failed reperfusion patients (n=62), those reperfused after 4 to 5 passes (n=62) had a favorable shift in the overall modified Rankin Scale score distribution (adjusted odds ratio, 3.992 [95% CI, 1.807–8.512], P =0.001] and higher rates of functional independence (31% versus 8.9%, P =0.004, adjusted odds ratio; 9.860 [95% CI, 2.323–41.845], P =0.002) at 90 days. Similarly, when compared with a matched group of failed reperfusion (n=42), patients reperfused after ≥6 passes (n=42) demonstrated a favorable shift in the overall modified Rankin Scale score distribution (adjusted odds ratio, 2.640 [95% CI, 1.073–6.686], P =0.037) and had higher rates of functional independence (36.8% vs 11.1%, P =0.004, adjusted odds ratio, 5.392 [95% CI, 1.185–24.530], P =0.029) at 90 day. Rates of parenchymal hematoma type-2 and 90-day mortality were comparable in the reperfused and nonreperfused groups. Conclusions: Achieving reperfusion despite multiple passes leads to improved outcomes compared with failed procedures. Arbitrary uncontrolled thresholds for a maximum number of passes to predict futile recanalization may lead to inappropriate early termination of procedures.

Abstract P619: A Non-Linear Relationship Between Time From Onset to Endovascular Therapy and Outcomes in Patients With Acute Basilar Artery Occlusion in Clinical Practice

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Hongfei Sang ◽  
Junjie Yuan ◽  
Shuai Liu ◽  
Weidong Luo ◽  
Fengli Li ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Scale Score ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Symptomatic Intracerebral Hemorrhage

Objective: Faster time from onset to puncture (OPT) using endovascular therapy (EVT) in acute large-vessel occlusion of anterior circulation has been associated with better clinical outcomes. However, the relationship in acute basilar artery occlusion (BAO) is still not well delineated. Methods: We analyzed acute BAO patients receiving EVT from a nationwide registry of BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion study). The primary outcome was favorable functional outcome (defined as modified Rankin Scale score 0-3) at 90 days. Secondary outcomes included function independence (defined as modified Rankin Scale score 0-2), mortality and symptomatic intracerebral hemorrhage. The associations between OPT and outcomes were evaluated using multivariable logistic regression (OPT as a categorical variable) and restricted cubic spline regression (OPT as a continuous variable). Results: Among 639 eligible patients, the median age was 65 years, and median OPT was 328 mins (interquartile range, 220-490). Treatment within 4 hours were associated with higher rates of functional independence (adjusted OR, 0.60 [95% CI, 0.37-0.97] and 0.46 [95% CI, 0.22-0.97], respectively) and favorable outcome (adjusted OR, 0.63 [95% CI, 0.40-0.99] and 0.46 [95% CI, 0.24-0.96], respectively) compared with treatment within 4-8 hours and 8-12 hours. In the restricted cubic spline models, nonlinear relationships were consistently observed between OPT with favorable outcome, functional independence and mortality, with significant benefit loss throughout the first 10 hours but then a relative flat afterwards. However, the odds of symptomatic intracerebral hemorrhage did not significantly change with longer delay to EVT. Conclusion: Among patients with acute BAO in routine practice, earlier treatment with EVT was associated with better outcomes throughout the first 10 hours after onset, but benefit sustained unchanged afterwards. Future trials or pooled analysis of larger size BAO patients are needed to confirm these results.

Sign in / Sign up

Export Citation Format

Share Document