Stroke etiology and outcomes after endovascular thrombectomy: Results from the SITS registry and a meta-analysis

Marius Matusevicius, Charith Cooray, Viiu Marika Rand, Ana Paiva Nunes, Tiago Moreira, Rossana Tassi, Jose Antonio Egido, Jyrki Ollikainen, Guido Bigliardi, Staffan Holmin, Niaz Ahmed

Research output: Contribution to journalArticleScientificpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)388-400
Number of pages13
JournalJournal of stroke
Volume23
Issue number3
DOIs
Publication statusPublished - Sep 2021
Publication typeA1 Journal article-refereed

Keywords

  • Embolic stroke
  • Ischemic stroke
  • Meta-analysis
  • Review
  • Thrombectomy
  • Thrombotic stroke

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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