Header

UZH-Logo

Maintenance Infos

Outcome of endovascular therapy in stroke with large vessel occlusion and mild symptoms


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; = 0.840). Patients with EVT showed a nonsignificant trend toward higher mRS score at 3 months ( = 0.717), while the proportion of surviving patients with high disability was comparably very low in both groups ( = 0.419). Mortality was slightly higher among those with EVT (9.3% vs 2.8%; = 0.06), and symptomatic intracranial hemorrhage was a rare event in both groups (2.8% vs 0%; = 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.

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; = 0.840). Patients with EVT showed a nonsignificant trend toward higher mRS score at 3 months ( = 0.717), while the proportion of surviving patients with high disability was comparably very low in both groups ( = 0.419). Mortality was slightly higher among those with EVT (9.3% vs 2.8%; = 0.06), and symptomatic intracranial hemorrhage was a rare event in both groups (2.8% vs 0%; = 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.

Statistics

Citations

Dimensions.ai Metrics
3 citations in Web of Science®
3 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

1 download since deposited on 24 Jan 2020
1 download since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Neurology (clinical)
Language:English
Date:22 October 2019
Deposited On:24 Jan 2020 09:31
Last Modified:29 Jul 2020 11:46
Publisher:Lippincott Williams & Wilkins
ISSN:0028-3878
OA Status:Closed
Publisher DOI:https://doi.org/10.1212/WNL.0000000000008362
PubMed ID:31591276

Download

Closed Access: Download allowed only for UZH members