Laura Ludovica Gramegna1, Manuel Requena2, Lavinia Dinia3, Fernando Melendez3, David Hernández4, Pilar Coscojuela4, Manuel Quintana5, Carla Vert6, Marta Rubiera2, Marc Ribò2, Àlex Rovira6, Carlos Molina2, Alejandro Tomasello3. 1. Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy. Electronic address: lauraludovica.gramegna@gmail.com. 2. Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital Barcelona, Spain. 3. Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain; Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain. 4. Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain. 5. Department of Neurology, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Hospital Vall d'Hebron, Spain. 6. Neuroradiology Section and Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Endovascular treatment is considered a reasonable approach for patients with acute posterior circulation stroke, but it remains uncertain which patients will benefit the most from it. OBJECTIVE: To find independent clinical and angiographic predictors of outcome after endovascular treatment for posterior circulation stroke. METHODS: We evaluated consecutive patients with acute posterior circulation stroke who underwent endovascular treatment in our comprehensive stroke center from January 2015 to December 2017. Good outcome was defined as a modified Rankin score of 0-3 at 90 days. Intracranial atheromatous disease was established on focal stenosis recorded during endovascular treatment. Associations were sought between a good outcome and clinical and angiographic factors. Adjusted logistic regression models were used to define independent outcome predictors. RESULTS: Forty-seven consecutive patients were included: mean age 70.9 ± 12.1 years, median admission NIHSS score, 16 (IQR: 8-30). On univariate analysis, age (p = 0.01), smoking (p = 0.04), hypertension (p = 0.03), successful reperfusion (p = 0.04), presence of extracranial atherosclerosis (p = 0.02), and absence of atherosclerosis (p = 0.03) were significantly associated with a good outcome. On multivariate analysis, age <70 years (odds ratio = 6.20, 95%CI 1.52-25.47, p = 0.01) and absence of intracranial atherosclerosis (odds ratio = 6.45, 95% CI 1.09-38.24, p = 0.04) were independently associated with a good outcome. CONCLUSIONS: Pretreatment determination of the presence or absence of intracranial atherosclerosis can aid management of posterior circulation stroke patients. The absence of intracranial atherosclerosis may have value as a positive selection criterion for endovascular treatment in future trials. The presence of intracranial atherosclerosis could be used as a selection tool in future studies investigating new treatment protocols for this population.
BACKGROUND: Endovascular treatment is considered a reasonable approach for patients with acute posterior circulation stroke, but it remains uncertain which patients will benefit the most from it. OBJECTIVE: To find independent clinical and angiographic predictors of outcome after endovascular treatment for posterior circulation stroke. METHODS: We evaluated consecutive patients with acute posterior circulation stroke who underwent endovascular treatment in our comprehensive stroke center from January 2015 to December 2017. Good outcome was defined as a modified Rankin score of 0-3 at 90 days. Intracranial atheromatous disease was established on focal stenosis recorded during endovascular treatment. Associations were sought between a good outcome and clinical and angiographic factors. Adjusted logistic regression models were used to define independent outcome predictors. RESULTS: Forty-seven consecutive patients were included: mean age 70.9 ± 12.1 years, median admission NIHSS score, 16 (IQR: 8-30). On univariate analysis, age (p = 0.01), smoking (p = 0.04), hypertension (p = 0.03), successful reperfusion (p = 0.04), presence of extracranial atherosclerosis (p = 0.02), and absence of atherosclerosis (p = 0.03) were significantly associated with a good outcome. On multivariate analysis, age <70 years (odds ratio = 6.20, 95%CI 1.52-25.47, p = 0.01) and absence of intracranial atherosclerosis (odds ratio = 6.45, 95% CI 1.09-38.24, p = 0.04) were independently associated with a good outcome. CONCLUSIONS: Pretreatment determination of the presence or absence of intracranial atherosclerosis can aid management of posterior circulation strokepatients. The absence of intracranial atherosclerosis may have value as a positive selection criterion for endovascular treatment in future trials. The presence of intracranial atherosclerosis could be used as a selection tool in future studies investigating new treatment protocols for this population.
Authors: A M Alexandre; I Valente; A Consoli; M Piano; L Renieri; J D Gabrieli; R Russo; A A Caragliano; M Ruggiero; A Saletti; G A Lazzarotti; M Pileggi; N Limbucci; M Cosottini; A Cervo; F Viaro; S L Vinci; C Commodaro; F Pilato; A Pedicelli Journal: AJNR Am J Neuroradiol Date: 2021-03-04 Impact factor: 3.825