Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
Author:
Salsano Giancarlo1, Salsano Antonio2ORCID, Del Sette Bruno1, D’Alonzo Alessio1, Sassos Davide3, Alexandre Andrea4, Pedicelli Alessandro4, Di Iorio Riccardo5, Colò Francesca6, Castellan Lucio1
Affiliation:
1. Department of Radiology and Interventional Radiology, IRCCS Ospedale Policlinico San Martino , Genoa , Italy 2. DISC Department, University of Genova , Genoa , Italy 3. Clinica Neurologica IRCCS Azienda Ospedaliera Universitaria San Martino, IST , Genoa , Italy 4. UOSA Neuroradiology Unit, Department of Radiology, Radiotherapy and Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy 5. Neurology Unit, Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy 6. Department of Neurosciences, Catholic University School of Medicine , Rome , Italy
Abstract
Abstract
Introduction
In the absence of clinical trials, the benefit of endovascular therapy (EVT) on the treatment of acute ischemic stroke (AIS) with primary distal and medium vessel occlusions (DMVO) is still not well defined. The aim of the study is to evaluate EVT with or without intravenous thrombolysis (EVT ± IVT) in primary DMVO stroke in comparison with a control cohort treated with IVT alone.
Methods
We analysed all consecutive AIS with proven primary DMVO. Primary endpoints were excellent outcome, functional independence at 3 months follow-up, and early neurologic improvement at 1 day after treatment.
Results
One hundred and fourteen patients with DMVO strokes were included between 2019 and 2023. Propensity-weighted analysis showed no significant differences in EVT ± IVT vs IVT for the excellent outcome (adjusted OR [aOR], 1.575; 95% CI, 0.706–3.513), functional independence (aOR, 2.024; 95% CI, 0.845–4.848), early neurological improvement (aOR, 2.218; 95% CI, 0.937–5.247), mortality (aOR, 0.498; 95% CI, 0.177–1.406), symptomatic intracranial haemorrhage (aOR, 0.493; 95% CI, 0.102–2.385), and subarachnoid haemorrhage (aOR, 0.560; 95% CI, 0.143–2.187). The type of revascularization did not influence the percentage of cerebral volume lost (adjusted linear regression estimate, −19.171, t value, 11.562; p = 0.104).
Conclusions
This study supports the hypothesis that patients with primary DMVO stroke treated with EVT (±IVT) or IVT alone have comparable outcomes.
Publisher
Walter de Gruyter GmbH
Reference41 articles.
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