TY - JOUR
T1 - Stroke etiology and outcomes after endovascular thrombectomy
T2 - Results from the SITS registry and a meta-analysis
AU - Matusevicius, Marius
AU - Cooray, Charith
AU - Rand, Viiu Marika
AU - Nunes, Ana Paiva
AU - Moreira, Tiago
AU - Tassi, Rossana
AU - Egido, Jose Antonio
AU - Ollikainen, Jyrki
AU - Bigliardi, Guido
AU - Holmin, Staffan
AU - Ahmed, Niaz
N1 - Funding Information:
their centers for their participation. We thank the SITS Scientific Committee for overseeing SITS Scientific activities. We also thank all patients who participated in SITS Thrombectomy register. This study was funded directly or indirectly through several grants. No funding source has had any impact on the methodology or the presented results of this study. Marius Matusevi-cius, Charith Cooray, Tiago Moreira, Staffan Holmin, and Niaz Ahmed have received funding by the Stockholm Regional council. Marius Matusevicius, Charith Cooray, and Niaz Ahmed have received funding by the Swedish Stroke Foundation. Mar-ius Matusevicius, Tiago Moreira, Staffan Holmin, and Niaz Ahmed have received funding by the Karolinska Institute. Staffan Holmin has received funding from the Söderberg Foundations and MedTechLabs.
PY - 2021/9
Y1 - 2021/9
N2 - Background and Purpose The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT. Methods We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0–2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447). Results Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. Conclusions From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference be-tween etiologies with aggregate data.
AB - Background and Purpose The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT. Methods We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0–2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447). Results Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. Conclusions From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference be-tween etiologies with aggregate data.
KW - Embolic stroke
KW - Ischemic stroke
KW - Meta-analysis
KW - Review
KW - Thrombectomy
KW - Thrombotic stroke
U2 - 10.5853/jos.2021.00850
DO - 10.5853/jos.2021.00850
M3 - Article
AN - SCOPUS:85120672994
VL - 23
SP - 388
EP - 400
IS - 3
ER -