Concetta Manno1, Giulio Disanto1, Giovanni Bianco1, Stefania Nannoni1, Mirjam Heldner1, Simon Jung1, Marcel Arnold1, Johannes Kaesmacher1, Mandy Müller1, Sebastian Thilemann1, Henrik Gensicke1, Emmanuel Carrera1, Urs Fischer1, Timo Kahles1, Andreas Luft1, Krassen Nedeltchev1, Claudio Staedler1, Alessandro Cianfoni1, Georg Kägi1, Leo H Bonati1, Patrik Michel1, Carlo W Cereda2. 1. From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland. 2. From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland. carlo.cereda@eoc.ch.
Abstract
OBJECTIVE: To compare outcomes after endovascular therapy (EVT) and IV thrombolysis (IVT) in patients with stroke with emergent large vessel occlusion (LVO) and mild neurologic deficits. METHODS: This was a retrospective analysis of patients from the Swiss Stroke Registry with admission NIH Stroke Scale score ≤5 and LVO treated by EVT (± IVT) vs IVT alone. The primary endpoint was favorable functional outcome (modified Rankin Scale [mRS] score 0-1) at 3 months. Secondary outcomes were independence (mRS score 0-2), mRS score (ordinal shift analysis), and survival with high disability (mRS score 4-5). Safety endpoints were mortality and symptomatic hemorrhage. RESULTS: Of 11,356 patients, 312 met the criteria and propensity score method matched 108 in each group. A comparably large proportion of patients with EVT and IVT had favorable outcome (63% vs 65.7% respectively; odds ratio 0.94, 95% confidence interval 0.51-1.72; p = 0.840). Patients with EVT showed a nonsignificant trend toward higher mRS score at 3 months (p = 0.717), while the proportion of surviving patients with high disability was comparably very low in both groups (p = 0.419). Mortality was slightly higher among those with EVT (9.3% vs 2.8%; p = 0.06), and symptomatic intracranial hemorrhage was a rare event in both groups (2.8% vs 0%; p = 0.997). CONCLUSIONS: In acute ischemic stroke, EVT and IVT appear similarly effective in achieving favorable outcome at 3 months for patients with LVO and mild neurologic symptoms. EVT might be marginally inferior to IVT regarding outcome across all levels of disability and mortality. Further studies are required to determine whether certain subgroups of patients with LVO and mild symptoms benefit from EVT. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that patients with LVO and mild symptoms receiving either EVT or IVT had similar favorable functional outcomes at 3 months.
OBJECTIVE: To compare outcomes after endovascular therapy (EVT) and IV thrombolysis (IVT) in patients with stroke with emergent large vessel occlusion (LVO) and mild neurologic deficits. METHODS: This was a retrospective analysis of patients from the Swiss Stroke Registry with admission NIH Stroke Scale score ≤5 and LVO treated by EVT (± IVT) vs IVT alone. The primary endpoint was favorable functional outcome (modified Rankin Scale [mRS] score 0-1) at 3 months. Secondary outcomes were independence (mRS score 0-2), mRS score (ordinal shift analysis), and survival with high disability (mRS score 4-5). Safety endpoints were mortality and symptomatic hemorrhage. RESULTS: Of 11,356 patients, 312 met the criteria and propensity score method matched 108 in each group. A comparably large proportion of patients with EVT and IVT had favorable outcome (63% vs 65.7% respectively; odds ratio 0.94, 95% confidence interval 0.51-1.72; p = 0.840). Patients with EVT showed a nonsignificant trend toward higher mRS score at 3 months (p = 0.717), while the proportion of surviving patients with high disability was comparably very low in both groups (p = 0.419). Mortality was slightly higher among those with EVT (9.3% vs 2.8%; p = 0.06), and symptomatic intracranial hemorrhage was a rare event in both groups (2.8% vs 0%; p = 0.997). CONCLUSIONS: In acute ischemic stroke, EVT and IVT appear similarly effective in achieving favorable outcome at 3 months for patients with LVO and mild neurologic symptoms. EVT might be marginally inferior to IVT regarding outcome across all levels of disability and mortality. Further studies are required to determine whether certain subgroups of patients with LVO and mild symptoms benefit from EVT. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that patients with LVO and mild symptoms receiving either EVT or IVT had similar favorable functional outcomes at 3 months.
Authors: Valerian L Altersberger; Patrick R Wright; Sabine A Schaedelin; Gian Marco De Marchis; Henrik Gensicke; Stefan T Engelter; Marios Psychogios; Timo Kahles; Martina Goeldlin; Thomas R Meinel; Pasquale Mordasini; Johannes Kaesmacher; Alexander von Hessling; Jochen Vehoff; Johannes Weber; Susanne Wegener; Stephan Salmen; Rolf Sturzenegger; Friedrich Medlin; Christian Berger; Ludwig Schelosky; Susanne Renaud; Julien Niederhauser; Christophe Bonvin; Michael Schaerer; Marie-Luise Mono; Biljana Rodic; Guido Schwegler; Nils Peters; Manuel Bolognese; Andreas R Luft; Carlo W Cereda; Georg Kägi; Patrick Michel; Emmanuel Carrera; Marcel Arnold; Urs Fischer; Krassen Nedeltchev; Leo H Bonati Journal: Eur Stroke J Date: 2022-04-27
Authors: Martina B Goeldlin; Achim Mueller; Bernhard M Siepen; Madlaine Mueller; Davide Strambo; Patrik Michel; Michael Schaerer; Carlo W Cereda; Giovanni Bianco; Florian Lindheimer; Christian Berger; Friedrich Medlin; Roland Backhaus; Nils Peters; Susanne Renaud; Loraine Fisch; Julien Niederhaeuser; Emmanuel Carrera; Elisabeth Dirren; Christophe Bonvin; Rolf Sturzenegger; Timo Kahles; Krassen Nedeltchev; Georg Kaegi; Jochen Vehoff; Biljana Rodic; Manuel Bolognese; Ludwig Schelosky; Stephan Salmen; Marie-Luise Mono; Alexandros A Polymeris; Stefan T Engelter; Philippe Lyrer; Susanne Wegener; Andreas R Luft; Werner Z'Graggen; David Bervini; Bastian Volbers; Tomas Dobrocky; Johannes Kaesmacher; Pasquale Mordasini; Thomas R Meinel; Marcel Arnold; Javier Fandino; Leo H Bonati; Urs Fischer; David J Seiffge Journal: J Stroke Date: 2022-05-31 Impact factor: 8.632
Authors: Gian Marco De Marchis; Patrick R Wright; Patrik Michel; Davide Strambo; Emmanuel Carrera; Elisabeth Dirren; Andreas R Luft; Susanne Wegener; Carlo W Cereda; Georg Kägi; Jochen Vehoff; Henrik Gensicke; Philippe Lyrer; Krassen Nedeltchev; Timo Khales; Manuel Bolognese; Stephan Salmen; Rolf Sturzenegger; Christophe Bonvin; Christian Berger; Ludwig Schelosky; Marie-Luise Mono; Biljana Rodic; Andrea von Reding; Guido Schwegler; Alexander A Tarnutzer; Friedrich Medlin; Andrea M Humm; Nils Peters; Morin Beyeler; Lilian Kriemler; David Bervini; Javier Fandino; Lars G Hemkens; Pasquale Mordasini; Marcel Arnold; Urs Fischer; Leo H Bonati Journal: Eur J Neurol Date: 2022-01-04 Impact factor: 6.288
Authors: Urs Fischer; Mattia Branca; Leo H Bonati; Emmanuel Carrera; Maria I Vargas; Alexandra Platon; Zsolt Kulcsar; Susanne Wegener; Andreas Luft; David J Seiffge; Marcel Arnold; Patrik Michel; Davide Strambo; Vincent Dunet; Gian Marco De Marchis; Ludwig Schelosky; Gustav Andreisek; Filip Barinka; Nils Peters; Loraine Fisch; Krassen Nedeltchev; Carlo W Cereda; Georg Kägi; Manuel Bolognese; Stephan Salmen; Rolf Sturzenegger; Friedrich Medlin; Christian Berger; Susanne Renaud; Christophe Bonvin; Michael Schaerer; Marie-Luise Mono; Biljana Rodic; Marios Psychogios; Pasquale Mordasini; Jan Gralla; Johannes Kaesmacher; Thomas R Meinel Journal: Ann Neurol Date: 2022-06-10 Impact factor: 11.274
Authors: Thomas R Meinel; Mattia Branca; Gian Marco De Marchis; Krassen Nedeltchev; Timo Kahles; Leo Bonati; Marcel Arnold; Mirjam R Heldner; Simon Jung; Emmanuel Carrera; Elisabeth Dirren; Patrik Michel; Davide Strambo; Carlo W Cereda; Giovanni Bianco; Georg Kägi; Jochen Vehoff; Mira Katan; Manuel Bolognese; Roland Backhaus; Stephan Salmen; Sylvan Albert; Friedrich Medlin; Christian Berger; Ludwig Schelosky; Susanne Renaud; Julien Niederhauser; Christophe Bonvin; Michael Schaerer; Marie-Luise Mono; Biljana Rodic; Alexander A Tarnutzer; Pasquale Mordasini; Jan Gralla; Johannes Kaesmacher; Stefan Engelter; Urs Fischer; David J Seiffge Journal: Ann Neurol Date: 2020-10-17 Impact factor: 10.422