TY - JOUR
T1 - Recanalization Therapies for Large Vessel Occlusion Due to Cervical Artery Dissection
T2 - A Cohort Study of the EVA-TRISP Collaboration
AU - Traenka, Christopher
AU - Lorscheider, Johannes
AU - Hametner, Christian
AU - Baumgartner, Philipp
AU - Gralla, Jan
AU - Magoni, Mauro
AU - Martinez-Majander, Nicolas
AU - Casolla, Barbara
AU - Feil, Katharina
AU - Pascarella, Rosario
AU - Papanagiotou, Panagiotis
AU - Nordanstig, Annika
AU - Padjen, Visnja
AU - Cereda, Carlo W.
AU - Psychogios, Marios
AU - Nolte, Christian H.
AU - Zini, Andrea
AU - Michel, Patrik
AU - Béjot, Yannick
AU - Kastrup, Andreas
AU - Zedde, Marialuisa
AU - Kägi, Georg
AU - Kellert, Lars
AU - Henon, Hilde
AU - Curtze, Sami
AU - Pezzini, Alessandro
AU - Arnold, Marcel
AU - Wegener, Susanne
AU - Ringleb, Peter
AU - Tatlisumak, Turgut
AU - EVA-TRISP Collaborators
AU - Nederkoorn, Paul J.
AU - Engelter, Stefan T.
AU - Gensicke, Henrik
N1 - Funding Information: and research support from Daiichi-Sankyo, the Science Funds [Wissenschaftsfonds] of the University Hospital Basel, the University Basel, from the “Wissenschaftsfonds Rehabilitation” of the University Hospital for Geriatric Medicine Felix Platter, the “Freiwillige Akademische Gesellschaft Basel,” the Swiss Heart Funding Information: Turgut Tatlisumak has received academic grants from University of Gothenburg, Sahlgrenska University Hospital, Sigrid Juse-lius Foundation, Wennerström Foundation, and European Union. Dr. Tatlisumak serves/has served on advisory boards from Bayer, Bristol Myers Squibb, Portola Pharma, and Inventiva. Funding Information: Marcel Arnold received Speaker honoraria from Bayer, Boehringer Ingelheim, and Covidien; Scientific advisory board honoraria from Amgen, Bayer, Boehringer Ingelheim, BMS, Pfizer, Covidien, Daichy Sankyo and Nestlé Health Science. Research grants from the Swiss Heart Foundation and the Swiss National Science Foundation. Funding Information: Christian H. Nolte research grants from German Ministry of Research and Education, German Center for Neurodegenerative Diseases, German Center for cardiovascular Research, and speaker and/or consultation fees from Abbott, Alexion, Boehringer In-gelheim, Bristol-Myers Squibb, Daiichi Sankyo and Pfizer Pharma. Funding Information: Henrik Gensicke has received research support from the Swiss National Science Foundation, advisory board honoraria from Daiichi Sankyo and funding for travel from BMS/Pfizer. All other authors report no relevant disclosures. Funding Information: Georg Kägi has received modest honoraria for travel and advisory board from Bayer, Boehringer-Ingelheim and Zambon and a research grant from the Swiss Heart Foundation, Swiss Parkinson Foundation, Swiss National Science Foundation. Funding Information: Jan Gralla reports receiving grants from Medtronic Global during the conduct of the study and grants from Swiss National Science Foundation outside the submitted work. Mauro Magoni reports no disclosures. Nicolas Martinez-Majander reports no disclosures. Funding Information: Susanne Wegener received research funds by the Swiss National Science Foundation, the UZH Clinical research priority program (CRPP) stroke, the Swiss Heart foundation, the Zurich Neuroscience Center (ZNZ), Boehringer-Ingelheim (2016), speaker honoraria from Amgen (2018), Springer (2021), Teva. Funding Information: Carlo W. Cereda has received modest honoraria for scientific advisory board from iSchemaview and Bayer; Research grants from the Swiss Heart Foundation. Marios Psychogios reports no disclosures. Funding Information: Alessandro Pezzini has received research grants from Associ-azione Italiana per la Lotta alla Trombosi e alle Malattie Cardio-vascolari (ALT). Funding Information: Paul J. Nederkoorn has received funding from the Dutch Heart Foundation for acute stroke intervention trials in the Collaboration for New Trials in Stroke (CONTRAST) consortium. Funding Information: Christopher Traenka has received research grants from the Swiss Heart Foundation. He has received personal research scholarships from the Novartis Foundation for biological and medical research, the Freiwillige Akademische Gesellschaft Basel, the Bangerter-Rhyner Foundation, and the University of Basel. He has received travel grants from Bayer. Johannes Lorscheider has received research grants from Inno-suisse – Swiss Innovation Agency, Biogen and Novartis. He has received consulting and/or speaking fees from Novartis, Roche and Teva. Christian Hametner reports no disclosures. Philipp Baumgartner reports no disclosures. Publisher Copyright: © 2023 Korean Stroke Society.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Background and Purpose This study aimed to investigate the effect of endovascular treatment (EVT, with or without intravenous thrombolysis [IVT]) versus IVT alone on outcomes in patients with acute ischemic stroke (AIS) and intracranial large vessel occlusion (LVO) attributable to cervical artery dissection (CeAD). Methods This multinational cohort study was conducted based on prospectively collected data from the EVA-TRISP (EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients) collaboration. Consecutive patients (2015–2019) with AIS-LVO attributable to CeAD treated with EVT and/or IVT were included. Primary outcome measures were (1) favorable 3-month outcome (modified Rankin Scale score 0–2) and (2) complete recanalization (thrombolysis in cerebral infarction scale 2b/3). Odds ratios with 95% confidence intervals (OR [95% CI]) from logistic regression models were calculated (unadjusted, adjusted). Secondary analyses were performed in the patients with LVO in the anterior circulation (LVOant) including propensity score matching. Results Among 290 patients, 222 (76.6%) had EVT and 68 (23.4%) IVT alone. EVT-treated patients had more severe strokes (National Institutes of Health Stroke Scale score, median [interquartile range]: 14 [10–19] vs. 4 [2–7], P<0.001). The frequency of favorable 3-month outcome did not differ significantly between both groups (EVT: 64.0% vs. IVT: 86.8%; ORadjusted 0.56 [0.24–1.32]). EVT was associated with higher rates of recanalization (80.5% vs. 40.7%; ORadjusted 8.85 [4.28–18.29]) compared to IVT. All secondary analyses showed higher recanalization rates in the EVT-group, which however never translated into better functional outcome rates compared to the IVT-group. Conclusion We observed no signal of superiority of EVT over IVT regarding functional outcome in CeAD-patients with AIS and LVO despite higher rates of complete recanalization with EVT. Whether pathophysiological CeAD-characteristics or their younger age might explain this observation deserves further research.
AB - Background and Purpose This study aimed to investigate the effect of endovascular treatment (EVT, with or without intravenous thrombolysis [IVT]) versus IVT alone on outcomes in patients with acute ischemic stroke (AIS) and intracranial large vessel occlusion (LVO) attributable to cervical artery dissection (CeAD). Methods This multinational cohort study was conducted based on prospectively collected data from the EVA-TRISP (EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients) collaboration. Consecutive patients (2015–2019) with AIS-LVO attributable to CeAD treated with EVT and/or IVT were included. Primary outcome measures were (1) favorable 3-month outcome (modified Rankin Scale score 0–2) and (2) complete recanalization (thrombolysis in cerebral infarction scale 2b/3). Odds ratios with 95% confidence intervals (OR [95% CI]) from logistic regression models were calculated (unadjusted, adjusted). Secondary analyses were performed in the patients with LVO in the anterior circulation (LVOant) including propensity score matching. Results Among 290 patients, 222 (76.6%) had EVT and 68 (23.4%) IVT alone. EVT-treated patients had more severe strokes (National Institutes of Health Stroke Scale score, median [interquartile range]: 14 [10–19] vs. 4 [2–7], P<0.001). The frequency of favorable 3-month outcome did not differ significantly between both groups (EVT: 64.0% vs. IVT: 86.8%; ORadjusted 0.56 [0.24–1.32]). EVT was associated with higher rates of recanalization (80.5% vs. 40.7%; ORadjusted 8.85 [4.28–18.29]) compared to IVT. All secondary analyses showed higher recanalization rates in the EVT-group, which however never translated into better functional outcome rates compared to the IVT-group. Conclusion We observed no signal of superiority of EVT over IVT regarding functional outcome in CeAD-patients with AIS and LVO despite higher rates of complete recanalization with EVT. Whether pathophysiological CeAD-characteristics or their younger age might explain this observation deserves further research.
KW - Cervical artery dissection
KW - Endovascular treatment
KW - Stroke
KW - Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=85164439973&partnerID=8YFLogxK
U2 - https://doi.org/10.5853/jos.2022.03370
DO - https://doi.org/10.5853/jos.2022.03370
M3 - Article
C2 - 37282374
SN - 2287-6391
VL - 25
SP - 272
EP - 281
JO - Journal of Stroke
JF - Journal of Stroke
IS - 2
ER -