Outcomes of Mechanical Thrombectomy in Patients With Acute Basilar Artery Occlusion With Mild to Moderate Symptoms

被引：1

作者：

Nicolini, Ettore ^{[1
,2
]}

Pracucci, Giovanni

Ciacciarelli, Antonio ^{[3
,4
]}

Saia, Valentina ^{[5
]}

Limbucci, Nicola ^{[6
]}

Nencini, Patrizia ^{[7
]}

Ruggiero, Maria ^{[8
]}

Longoni, Marco ^{[9
]}

Cosottini, Mirco

Orlandi, Giovanni

Bergui, Mauro

Cerrato, Paolo

Vallone, Stefano ^{[10
]}

Bigliardi, Guido ^{[11
]}

Cioni, Samuele ^{[12
]}

Tassi, Rossana ^{[13
]}

Da Ros, Valerio ^{[14
]}

Diomedi, Marina ^{[15
]}

Simonetti, Luigi ^{[16
]}

Zini, Andrea ^{[17
,18
]}

Velo, Mariano ^{[19
]}

La Spina, Paolo La ^{[20
]}

Castellan, Lucio ^{[21
]}

Del Sette, Massimo ^{[22
]}

De Michele, Manuela ^{[3
,4
]}

Lorenzano, Svetlana ^{[1
]}

Casetta, Ilaria ^{[23
]}

Fainardi, Enrico ^{[24
]}

Sallustio, Fabrizio ^{[2
]}

Menozzi, Roberto ^{[25
]}

Pezzini, Alessandro ^{[26
]}

Romano, Daniele G.

Frauenfelder, Giulia ^{[27
]}

Nappini, Sergio ^{[28
]}

Loizzo, Nicola ^{[29
]}

Saletti, Andrea

De Vito, Alessandro ^{[30
]}

Augelli, Raffaele ^{[31
]}

Cappellari, Manuel ^{[32
]}

Zimatore, Domenico Sergio ^{[33
]}

Petruzzellis, Marco ^{[34
]}

Allegretti, Luca ^{[35
]}

Tassinari, Tiziana ^{[5
]}

Ajello, Daniele ^{[36
]}

Marcheselli, Simona ^{[37
]}

Ganimede, Maria Porzia ^{[38
]}

Boero, Giovanni ^{[39
]}

Mangiafico, Salvatore ^{[40
]}

Ahmed, Niaz ^{[41
]}

Toni, Danilo ^{[1
]}

机构：

[1] Sapienza Univ Rome, Dept Human Neurosci, Rome, Italy

[2] Osped Castelli, Stroke Unit, Ariccia, Italy

[3] Univ Florence, Dept NEUROFARBA, Neurosci Sect, Florence, Italy

[4] Sapienza Univ Rome, Stroke Unit, Policlin Umberto 1, Rome, Italy

[5] S Corona Hosp, Neurol & Stroke Unit, Pietra Ligure, Italy

[6] Careggi Univ Hosp, Intervent Neurovasc Unit, Florence, Italy

[7] Careggi Univ Hosp, Florence, Italy

[8] AUSL Romagna Cesena, Siena, Italy

[9] Osped Bufalini Cesena, Neurol & Stroke Unit, Siena, Italy

[10] UO Neuroradiol, Siena, Italy

[11] Osped Civile Baggiovara AOU Modena, Neurol Stroke Unit, Siena, Italy

[12] UOC Neuroradiol diagnost & terapeut AOU Senese, Siena, Italy

[13] UOC Stroke Unit AOU Senese, Siena, Italy

[14] UOSD radiol interventist, Dipartimento Biomed & Prevenz, Genoa, Italy

[15] Univ Roma Tor Vergata, Dept Syst Med, Genoa, Italy

[16] UOC Neuroradiol Osped Bellaria, IRCCS Ist Sci Neurol Bologna, Genoa, Italy

[17] IRCCS Ist Sci Neurol Bologna, Dept Neurol, Bologna, Italy

[18] Maggiore Hosp, Stroke Ctr, Bologna, Italy

[19] UOC Neuroradiol AOU G Martino Messina, Messina, Italy

[20] UOSD Stroke Unit AOUG Martino Messina, Messina, Italy

[21] UO Neuroradiol Osped Policlin San Martino, Genoa, Italy

[22] UO Neurol Osped Policlin San Martino, Genoa, Italy

[23] Univ Hosp Arcispedale S Anna, Neurol Unit, Ferrara, Italy

[24] Univ Firenze, Osped Univ Careggi, Dipartimento Sci Biomed, Sperimentali & Clin Neuroradiol, Florence, Italy

[25] Azienda Osped Univ, Unita Complessa Neuroradiol, Parma, Italy

[26] Univ Parma, Dipartimento Med & Chirurg, Dipartimento Emergenza Urgenza, Programma Stroke Care, Parma, Italy

[27] UOSD Interventist AOU Salerno, Pavia, Italy

[28] IRCCS Policlin San Matteo, Radiol & Neuroradiol diagnost & interventist, Pavia, Italy

[29] IRCCS Fdn Mondino, UO Neurol Urgenza & Stroke Unit, Pavia, Italy

[30] UO Neuroradiol Dip Neurosci AZOU Ferrara, Pietra Ligure, Italy

[31] Osped circolo ASST Settelaghi Varese, Neuroradiol Dept, Pietra Ligure, Italy

[32] Azienda Osped Univ Integrata Verona, Stroke Unit, Pietra Ligure, Italy

[33] UO Neuroradiol AOU Consorziale Policlin Bari, Pietra Ligure, Italy

[34] AOU Consorziale Policlin Bari, UOC Neurol & Stroke Unit Puca, Pietra Ligure, Italy

[35] S Corona Hosp, SC Neuroradiol Diagnost & Interventist, Pietra Ligure, Italy

[36] UO Neuroradiol interventist, Rozzano, Italy

[37] IRCCS Humanitas Res Hosp, Neurol urgenza & Stroke Unit, Rozzano, Italy

[38] UOC Neuroradiol, Taranto, Italy

[39] Osped SS Annunziata, UOC Neurol, Taranto, Italy

[40] IRCCS Neuromed, Pozzilli, IS, Italy

[41] Karolinska Inst, Dept Clin Nurosci, Stockholm, Sweden

[42] Neuroctr Southern Switzerland, Stroke Ctr EOC, Lugano, Switzerland

[43] Univ SvizzeraItaliana, Fac Biomed Sci, Lugano, Switzerland

来源：

NEUROLOGY | 2024年 / 103卷 / 12期

关键词：

ACUTE ISCHEMIC-STROKE; TARGET TRIAL EMULATION; OF-HEALTH STROKE; ENDOVASCULAR TREATMENT; CAUSAL INFERENCE; THROMBOLYSIS; ALTEPLASE; THERAPY; DESIGN;

D O I：

10.1212/WNL.0000000000210086

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Objectives The benefit of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) with basilar artery occlusion (BAO) and a baseline National Institute of Health Stroke Scale (NIHSS) score <10 is unclear because this subpopulation has been substantially excluded from large clinical trials. The aim of our study was to determine whether MT +/- IV thrombolysis (IVT) improves functional outcomes compared with IVT alone in patients with BAO and a NIHSS score <10. Methods We emulated a hypothetical trial including adult patients with BAO, a baseline NIHSS score <10, and prestroke modified Rankin scale (mRS) scores 0-2, comparing MT (+/- IVT) with IVT alone. We acquired data from patients receiving MT (+/- IVT) within 24 hours of onset from the Italian Registry of Endovascular Treatment in Acute Stroke and data from patients treated only with IVT within 9 hours of symptom onset from the SITS International Stroke Thrombolysis Register, from 2011 until 2021. We used inverse probability weighting (IPW) adjusted for prespecified covariates to weight each individual's contribution to the outcome. The primary outcome was 90-day mRS scores 0-2. Secondary outcomes included 90-day mRS scores 0-1, 90-day mRS scores 4-5, mortality at 90 days, in-hospital death, and symptomatic intracerebral hemorrhage. Results Among the 764 patients recruited from the 2 databases (477 men [62.4%]; mean age [+/- SD] 67.88 [+/- 13.9] years), 410 (53.7%) received MT +/- IVT and 354 (46.3%) only IVT. After applying IPW, our population was composed of 710 MT and 707 IVT patients. Of these, 454 MT-treated (63.9%) and 383 IVT-treated (54.2%) patients had a 90-day mRS score of 0-2 (adjusted odds ratio (aOR) 1.56 [95% CI 1.04-2.03]). MT was also associated with a higher rate of mRS scores 0-1 (aOR 2.01 [95% CI 1.37-2.95]) and a lower rate of in-hospital death (aOR 0.45 [95% CI 0.25-0.78]). Among the subgroups tested, MT had a larger effect on 90-day mRS scores 0-2 for patients with NIHSS scores 6-9 than for patients with a NIHSS score <6 (p for interaction 0.02). Discussion In a large-scale target trial emulation on patients with stroke from BAO and a NIHSS score <10, MT was associated with better functional outcomes compared with IVT alone. Further research is needed to confirm the benefit of MT in patients with a NIHSS score <6. Classification of Evidence This study provides Class III evidence that MT +/- intravenous thrombolysis is associated with better 90-day functional outcomes in patients with BAO and a NIHSS score < 10 compared with intravenous thrombolysis alone.

引用

页数：12

共 28 条

[1] Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials [J].

Abdalkader, Mohamad ;

Finitsis, Stephanos ;

Li, Chuanhui ;

Hu, Wei ;

Liu, Xinfeng ;

Ji, Xunming ;

Huo, Xiaochuan ;

Alemseged, Fana ;

Qiu, Zhongming ;

Strbian, Daniel ;

Puetz, Volker ;

Siegler, James E. ;

Yaghi, Shadi ;

Asif, Kaiz ;

Klein, Piers ;

Zhu, Yuyou ;

Campbell, Bruce C. V. ;

Chen, Hui-Sheng ;

Nagel, Simon ;

Tsivgoulis, Georgios ;

Miao, Zhongrong ;

Nogueira, Raul G. ;

Jovin, Tudor G. ;

Schonewille, Wouter J. ;

Nguyen, Thanh N. .

JOURNAL OF STROKE, 2023, 25 (01) :81-91

[2] Endovascular Therapy for Basilar Artery Occlusion [J].

Alemseged, Fana ;

Nguyen, Thanh N. ;

Alverne, Francisco Mont' ;

Liu, Xinfeng ;

Schonewille, Wouter J. ;

Nogueira, Raul G. .

STROKE, 2023, 54 (04) :1127-1137

[3] Posterior National Institutes of Health Stroke Scale Improves Prognostic Accuracy in Posterior Circulation Stroke [J].

Alemseged, Fana ;

Rocco, Alessandro ;

Arba, Francesco ;

Schwabova, Jaroslava Paulasova ;

Wu, Teddy ;

Cavicchia, Leone ;

Ng, Felix ;

Ng, Jo Lyn ;

Zhao, Henry ;

Williams, Cameron ;

Sallustio, Fabrizio ;

Balabanski, Anna H. ;

Tomek, Ales ;

Parson, Mark W. ;

Mitchell, Peter J. ;

Diomedi, Marina ;

Yassi, Nawaf ;

Churilov, Leonid ;

Davis, Stephen M. ;

Campbell, Bruce C., V .

STROKE, 2022, 53 (04) :1247-1255

[4] European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke [J].

Berge, Eivind ;

Whiteley, William ;

Audebert, Heinrich ;

Marchis, Gian Marco De ;

Fonseca, Ana Catarina ;

Padiglioni, Chiara ;

Ossa, Natalia Perez de la ;

Strbian, Daniel ;

Tsivgoulis, Georgios ;

Turc, Guillaume .

EUROPEAN STROKE JOURNAL, 2021, 6 (01) :I-LXII

[5] Perfusion Imaging Predicts Favorable Outcomes after Basilar Artery Thrombectomy [J].

Cereda, Carlo W. ;

Bianco, Giovanni ;

Mlynash, Michael ;

Yuen, Nicole ;

Qureshi, Abid Y. ;

Hinduja, Archana ;

Dehkharghani, Seena ;

Goldman-Yassen, Adam E. ;

Hsieh, Kevin Li-Chun ;

Giurgiutiu, Dan-Victor ;

Gibson, Dan ;

Carrera, Emmanuel ;

Alemseged, Fana ;

Faizy, Tobias D. ;

Fiehler, Jens ;

Pileggi, Marco ;

Campbell, Bruce ;

Albers, Gregory W. ;

Heit, Jeremy J. .

ANNALS OF NEUROLOGY, 2022, 91 (01) :23-32

[6]

Danilo T., 2023, Linea Guida Terapie di rivascolarizzazione dellictus ischemico acuto

[7] Target Trial Emulation to Improve Causal Inference from Observational Data: What, Why, and How? [J].

Fu, Edouard L. .

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2023, 34 (08) :1305-1314

[8] Thrombectomy for Basilar Artery Occlusion with Mild Symptoms [J].

Guenego, Adrien ;

Dargazanli, Cyril ;

Weisenburger-Lile, David ;

Gory, Benjamin ;

Richard, Sebastien ;

Ducroux, Celina ;

Piotin, Michel ;

Blanc, Raphael ;

Labreuche, Julien ;

Lucas, Ludovic ;

Aubertin, Mathilde ;

Benali, Amel ;

Bourcier, Romain ;

Detraz, Lili ;

Vannier, Stephane ;

Guillen, Maud ;

Eugene, Francois ;

Walker, Gregory ;

Lun, Ronda ;

Consoli, Arturo ;

Lapergue, Bertrand ;

Fahed, Robert .

WORLD NEUROSURGERY, 2021, 149 :E400-E414

[9] Association Between Early Treatment With Tocilizumab and Mortality Among Critically Ill Patients With COVID-19 [J].

Gupta, Shruti ;

Wang, Wei ;

Hayek, Salim S. ;

Chan, Lili ;

Mathews, Kusum S. ;

Melamed, Michal L. ;

Brenner, Samantha K. ;

Leonberg-Yoo, Amanda ;

Schenck, Edward J. ;

Radbel, Jared ;

Reiser, Jochen ;

Bansal, Anip ;

Srivastava, Anand ;

Zhou, Yan ;

Finkel, Diana ;

Green, Adam ;

Mallappallil, Mary ;

Faugno, Anthony J. ;

Zhang, Jingjing ;

Velez, Juan Carlos Q. ;

Shaefi, Shahzad ;

Parikh, Chirag R. ;

Charytan, David M. ;

Athavale, Ambarish M. ;

Friedman, Allon N. ;

Redfern, Roberta E. ;

Short, Samuel A. P. ;

Correa, Simon ;

Pokharel, Kapil K. ;

Admon, Andrew J. ;

Donnelly, John P. ;

Gershengorn, Hayley B. ;

Douin, David J. ;

Semler, Matthew W. ;

Hernan, Miguel A. ;

Leaf, David E. .

JAMA INTERNAL MEDICINE, 2021, 181 (01) :41-51

[10] Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II) [J].

Hacke, W ;

Kaste, M ;

Fieschi, C ;

von Kummer, R ;

Davalos, A ;

Meier, D ;

Larrue, V ;

Bluhmki, E ;

Davis, S ;

Donnan, G ;

Schneider, D ;

Diez-Tejedor, E ;

Trouillas, P .

LANCET, 1998, 352 (9136) :1245-1251

← 1 2 3 →