Stroke Etiology Modifies the Effect of Endovascular Treatment in Acute Stroke
Author:
Tiedt Steffen1, Herzberg Moriz12, Küpper Clemens3, Feil Katharina3, Kellert Lars3, Dorn Franziska2, Liebig Thomas2, Alegiani Anna4, Dichgans Martin5, Wollenweber Frank A.13, Alber B., Bangard C., Berrouschot J., Bode F.J., Boeckh-Behrens T., Bohner G., Bormann A., Braun M., Eckert B., Fiehler J., Flottmann F., Gerloff C., Hamann G.F., Henn K.H., Kastrup A., Kraemer C., Krause L., Lehm M., Liman J., Lowens S., Mpotsaris A., Nolte C.H., Papanagiotou P., Petersen M., Petzold G.C., Pfeilschifter W., Psychogios M.N., Reich A., von Rennenberg R., Röther J., Schäfer J.H., Siebert E., Siedow A., Solymosi L., Thomalla G., Thonke S., Wagner M., Wunderlich S., Zweynert S.
Affiliation:
1. From the Institute for Stroke and Dementia Research (S.T., M.D., F.A.W.), University Hospital, LMU Munich, Germany 2. Institute of Neuroradiology (M.H., F.D., T.L.), University Hospital, LMU Munich, Germany 3. Department of Neurology (C.K., K.F., L.K., F.A.W.), University Hospital, LMU Munich, Germany 4. Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (A.A.) 5. Munich Cluster for Systems Neurology, Germany (M.D.).
Abstract
Background and Purpose—
Stroke etiology drives thrombus composition. We thus hypothesized that endovascular treatment shows different efficacy in cardioembolic versus noncardioembolic large-vessel occlusions (LVOs).
Methods—
Procedural characteristics, grade of reperfusion, and functional outcome at discharge and 90 days were compared between patients with cardioembolic versus noncardioembolic LVO from the GSR-ET (German Stroke Registry–Endovascular Treatment; n=2589). To determine associations with functional outcome, adjusted odds ratios and 95% CIs were calculated using ordinal multivariable logistic regression models adjusting for potential baseline confounder variables.
Results—
Endovascular treatment of cardioembolic LVO had a higher rate of successful reperfusion (85.6% versus 81.0%;
P
=0.002) and a higher rate of complete reperfusion after a single thrombectomy pass (45.7% versus 38.1%;
P
<0.001) compared with noncardioembolic LVO. Cardioembolic LVO was associated with better functional outcome at discharge (adjusted odds ratio, 1.61 [95% CI, 1.37–1.88]) and 90 days (adjusted odds ratio, 1.29 [95% CI, 1.09–1.53]). In mediation analysis, reperfusion explained 47% of the effect of etiology on functional outcome at discharge.
Conclusions—
These results provide evidence for higher efficacy of endovascular treatment in cardioembolic LVO compared with noncardioembolic LVO.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology
Cited by
35 articles.
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