Stroke: Vascular and Interventional Neurology (Sep 2024)
Endovascular Thrombectomy With and Without Preceding Thrombolysis in Posterior Circulation Stroke—Insights From STAR
- Ev‐Christin Heide,
- Sami Al Kasab,
- Ali Alawieh,
- Adam Arthur,
- Waleed Brinjikji,
- Shakeel Chowdhry,
- Roberto Crosa,
- Hugo Cuellar,
- Reade De Leacy,
- Travis Dumont,
- Marielle Ernst,
- Mohamad Ezzeldin,
- Isabel Fragata,
- Brian Howard,
- Pascal Jabbour,
- Peter Kan,
- Joon‐Tae Kim,
- Michael R. Levitt,
- Justin Mascitelli,
- Charles Matouk,
- Mark Moss,
- Pedro Navia,
- Joshua Osbun,
- Min S. Park,
- Adam Polifka,
- Marios‐Nikos Psychogios,
- Ansaar Rai,
- Daniele G. Romano,
- Amir Shaban,
- Robert M. Starke,
- Omar Tanweer,
- Richard Williamson,
- Stacey Q. Wolfe,
- Shinichi Yoshimura,
- Alejandro M. Spiotta,
- Ilko L. Maier
Affiliations
- Ev‐Christin Heide
- Department of Neurology University Medical Center Goettingen Germany
- Sami Al Kasab
- Department of Neurosurgery and Department of Neurology Medical University of South Carolina Charleston SC
- Ali Alawieh
- Department of Neurosurgery Emory University School of Medicine Atlanta GA
- Adam Arthur
- Department of Neurosurgery Semmes‐Murphey Neurologic and Spine Clinic University of Tennessee Health Science Center Memphis TN
- Waleed Brinjikji
- Department of Radiology Mayo Clinic Rochester MN
- Shakeel Chowdhry
- North Shore University Health System Evanston IL
- Roberto Crosa
- Department of Neurosurgery Endovascular Neurological Center Montevideo Uruguay
- Hugo Cuellar
- Department of Neurosurgery Louisiana State University Health Shreveport LA
- Reade De Leacy
- Department of Neurosurgery Mount Sinai Health System New York NY
- Travis Dumont
- Department of Neurosurgery University of Arizona Tuscon AZ
- Marielle Ernst
- Department of Neuroradiology University Medical Center Goettingen Germany
- Mohamad Ezzeldin
- Department of Clinical Sciences College of Medicine University of Houston Houston TX
- Isabel Fragata
- Neuroradiology Department Centro Hospitalar Universitário de Lisboa Central Lisboa Portugal
- Brian Howard
- Department of Neurosurgery Emory University School of Medicine Atlanta GA
- Pascal Jabbour
- Department of Neurosurgery Thomas Jefferson University Hospitals Philadelphia PA
- Peter Kan
- Department of Neurosurgery University of Texas Medical Branch Galveston TX
- Joon‐Tae Kim
- Department of Neurology Chonnam National University Medical School Chonnam National University Hospital Gwangju South Korea
- Michael R. Levitt
- Department of Neurosurgery University of Washington Seattle WA
- Justin Mascitelli
- Department of Neurosurgery University of Texas Health Science Center San Antonio TX
- Charles Matouk
- Department of Neurosurgery Yale School of Medicine New Haven CT
- Mark Moss
- Department of Interventional Neuroradiology Washington Regional Medical Center Fayetteville AR
- Pedro Navia
- Interventional and Diagnostic Neuroradiology Hospital Universitario La Paz Madrid Spain
- Joshua Osbun
- Department of Neurosurgery Washington University of School of Medicine St. Louis MO
- Min S. Park
- Department of Neurosurgery University of Virginia Charlottesville VA
- Adam Polifka
- Department of Neurosurgery University of Florida Gainesville FL
- Marios‐Nikos Psychogios
- Department of interventional and diagnostical Neuroradiology University of Basel Basel Switzerland
- Ansaar Rai
- Department of Radiology West Virginia School of Medicine Morgantown WV
- Daniele G. Romano
- University Hospital of Siena Siena Italy
- Amir Shaban
- Department of Neurology University of Iowa Hospitals and Clinics Iowa City IA
- Robert M. Starke
- Department of Neurosurgery University of Miami Health System Miami FL
- Omar Tanweer
- Department of Neurosurgery Baylor College of Medicine Houston TX
- Richard Williamson
- Department of Neurosurgery Allegheny Health Network Pittsburgh PA
- Stacey Q. Wolfe
- Department of Neurosurgery Wake Forest School of Medicine Winston‐Salem NC
- Shinichi Yoshimura
- Department of Neurosurgery Hyogo College of Medicine Nishinomiya Hyogo Japan
- Alejandro M. Spiotta
- Department of Neurological Surgery Medical University of South Carolina Charleston SC
- Ilko L. Maier
- Department of Neurology University Medical Center Goettingen Germany
- DOI
- https://doi.org/10.1161/SVIN.124.001334
- Journal volume & issue
-
Vol. 4,
no. 5
Abstract
Background Multiple randomized trials could not establish the noninferiority of endovascular thrombectomy (EVT) alone without preceding intravenous thrombolysis (IVT) or superiority of IVT followed by EVT in anterior circulation large‐vessel occlusion stroke. The role of prior IVT in posterior circulation large‐vessel occlusion remains controversial. Methods In this multicenter, retrospective study, patients with stroke with large‐vessel occlusion in the posterior circulation who received EVT alone or with IVT were selected from the stroke thrombectomy and aneurysm registry between 2013 and 2022. Effects of IVT followed by thrombectomy on favorable functional outcome (defined as modified Rankin scale≤3 at 90 days) and safety were investigated using multivariable logistic and linear regression models. Results Of the 588 included patients, 67% (n = 394) were treated with EVT alone and 29% (n = 170) with EVT after IVT, and 4% (n = 24) have missing values on this variable. Controlling for multiple confounding factors, IVT was not associated with a higher likelihood of favorable functional outcome at 90 days (odds ratio, 1.04 [95% CI, 0.52–2.09; P = 0.901). Thrombectomy alone did not show any safety advantages compared with those receiving IVT. Conclusion Similar functional outcomes and complication rates were seen in patients with posterior circulation large‐vessel occlusion treated with EVT alone versus EVT after IVT. Further prospective studies are required to determine the utility of IVT in posterior circulation stroke, especially in patients being directly admitted to thrombectomy centers.
Keywords
