Successful recanalization post endovascular therapy is associated with a decreased risk of intracranial haemorrhage: a retrospective study

Background: Although aneurysms rarely occur in the basilar artery (BA) trunk, the majority of those that do are dissection aneurysms. Currently, the mainstream therapy for BA trunk aneurysms is endovascular therapy (EVT), which mainly includes single coiling or conventional low-metal-coverage stent-assisted EVT, but the efficacy remains to be evaluated.Methods: A retrospective study was performed for the patients who were admitted to our institution for BA trunk aneurysms and underwent EVT. A total of 28 patients were collected in this study.Results: The patients were aged 23–71 years (53.7 ± 11.5 years on average); nine were female (32.1%, 9/28), and 19 were male (67.9%, 19/28). The patients were given single coiling or conventional low-metal-coverage stent-assisted EVT. Among the 28 patients, 10 (35.7%, 10/28) developed complications, 90% (9/10) of which were ischemic and 10% (1/10) were hemorrhagic. Among the 28 patients, 5 (17.9%, 5/28) died. The surviving 23 patients (82.1%, 23/28) recovered well.Conclusions: This study found that for BA trunk aneurysms, single coiling or conventional low-metal-coverage stent-assisted EVT still had some risks. The risks are mainly from brainstem ischemia. Therefore, the perforators of the BA trunk must be carefully evaluated and prevented from receiving damage from the EVT procedure. This study also shows that 82.1% of patients recovered well. Therefore, EVT can result in an acceptable prognosis.

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Factors Associated with Poor Outcomes in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke due to Large-Vessel Occlusion in Acute Anterior Circulation: A Retrospective Study

World Neurosurgery ◽

10.1016/j.wneu.2021.02.064 ◽

2021 ◽

Vol 149 ◽

pp. e128-e134

Author(s):

Yi-He Zhang ◽

Ming-Chao Shi ◽

Zhong-Xiu Wang ◽

Chao Li ◽

Meng-Yao Sun ◽

...

Keyword(s):

Ischemic Stroke ◽

Retrospective Study ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Factors Associated ◽

Poor Outcomes

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Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke – Results from the SWISS registry

European Stroke Journal ◽

10.1177/2396987317748545 ◽

2018 ◽

Vol 3 (1) ◽

pp. 47-56 ◽

Cited By ~ 10

Author(s):

Christopher Traenka ◽

Simon Jung ◽

Jan Gralla ◽

Rebekka Kurmann ◽

Christoph Stippich ◽

...

Keyword(s):

Confidence Interval ◽

Endovascular Therapy ◽

Odds Ratio ◽

Intracranial Haemorrhage ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Bridging Therapy ◽

Cervical Artery

Introduction In patients with stroke attributable to cervical artery dissection, we compared endovascular therapy to intravenous thrombolysis regarding three-month outcome, recanalisation and complications. Materials and methods In a multicentre intravenous thrombolysis/endovascular therapy-register-based cohort study, all consecutive cervical artery dissection patients with intracranial artery occlusion treated within 6 h were eligible for analysis. Endovascular therapy patients (with or without prior intravenous thrombolysis) were compared to intravenous thrombolysis patients regarding (i) excellent three-month outcome (modified Rankin Scale score 0–1), (ii) symptomatic intracranial haemorrhage, (iii) recanalisation of the occluded intracranial artery and (iv) death. Upon a systematic literature review, we performed a meta-analysis comparing endovascular therapy to intravenous thrombolysis in cervical artery dissection patients regarding three-month outcome using a random-effects Mantel–Haenszel model. Results Among 62 cervical artery dissection patients (median age 48.8 years), 24 received intravenous thrombolysis and 38 received endovascular therapy. Excellent three-month outcome occurred in 23.7% endovascular therapy and 20.8% with intravenous thrombolysis patients. Symptomatic intracranial haemorrhage occurred solely among endovascular therapy patients (5/38 patients, 13.2%) while four (80%) of these patients had bridging therapy; 6/38 endovascular therapy and 0/24 intravenous thrombolysis patients died. Four of these 6 endovascular therapy patients had bridging therapy. Recanalisation was achieved in 84.2% endovascular therapy patients and 66.7% intravenous thrombolysis patients (odds ratio 3.2, 95% confidence interval [0.9–11.38]). Sensitivity analyses in a subgroup treated within 4.5 h revealed a higher recanalisation rate among endovascular therapy patients (odds ratio 3.87, 95% confidence interval [1.00–14.95]), but no change in the key clinical findings. In a meta-analysis across eight studies (n = 212 patients), cervical artery dissection patients (110 intravenous thrombolysis and 102 endovascular therapy) showed identical odds for favourable outcome (odds ratio 0.97, 95% confidence interval [0.38–2.44]) among endovascular therapy patients and intravenous thrombolysis patients. Discussion and Conclusion In this cohort study, there was no clear signal of superiority of endovascular therapy over intravenous thrombolysis in cervical artery dissection patients, which – given the limitation of our sample size – does not prove that endovascular therapy in these patients cannot be superior in future studies. The observation that symptomatic intracranial haemorrhage and deaths in the endovascular therapy group occurred predominantly in bridging patients requires further investigation.

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