Endovascular therapy in the distal neurovascular territory: results of a large prospective registry.

Détails

ID Serval
serval:BIB_3A56B0985881
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Endovascular therapy in the distal neurovascular territory: results of a large prospective registry.
Périodique
Journal of neurointerventional surgery
Auteur(s)
Nogueira R.G., Mohammaden M.H., Haussen D.C., Budzik R.F., Gupta R., Krajina A., English J.D., Malek A.R., Sarraj A., Narata A.P., Taqi M.A., Frankel M.R., Miller T.R., Grobelny T., Baxter B.W., Bartolini B.M., Jenkins P., Estrade L., Liebeskind D., Veznedaroglu E.
Collaborateur(s)
Trevo Registry Investigators
ISSN
1759-8486 (Electronic)
ISSN-L
1759-8478
Statut éditorial
Publié
Date de publication
15/12/2020
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Résumé
There is a paucity of data regarding mechanical thrombectomy (MT) in distal arterial occlusions (DAO). We aim to evaluate the safety and efficacy of MT in patients with DAO and compare their outcomes with proximal arterial occlusion (PAO) strokes.
The Trevo Registry was a prospective open-label MT registry including 2008 patients from 76 sites across 12 countries. Patients were categorized into: PAO: intracranial ICA, and MCA-M1; and DAO: MCA-M2, MCA-M3, ACA, and PCA. Baseline and outcome variables were compared across the PAO vs DAO patients with pre-morbid mRS 0-2.
Among 407 DAOs including 350 (86.0%) M2, 25 (6.1%) M3, 10 (2.5%) ACA, and 22 (5.4%) PCA occlusions, there were 376 DAO with pre-morbid mRS 0-2 which were compared with 1268 PAO patients. The median baseline NIHSS score was lower in DAO (13 [8-18] vs 16 [12-20], P<0.001). There were no differences in terms of age, sex, IV-tPA use, co-morbidities, or time to treatment across DAO vs PAO. The rates of post-procedure reperfusion, symptomatic intracranial hemorrhage (sICH), and 90-mortality were comparable between both groups. DAO showed significantly higher rates of 90-day mRS 0-2 (68.3% vs 56.5%, P<0.001). After adjustment for potential confounders, the level of arterial occlusion was not associated with the chances of excellent outcome (DAO for 90-day mRS 0-1: OR; 1.18, 95% CI [0.90 to 1.54], P=0.225), successful reperfusion or SICH. However, DAO patients were more likely to be functionally independent (mRS 0-2: OR; 1.45, 95% CI [1,09 to 1.92], P=0.01) or dead (OR; 1.54, 95% CI [1.06 to 2.27], P=0.02) at 90 days.
Endovascular therapy in DAO appears to result in a comparable safety and technical success profile as in PAO. The potential benefits of DAO thrombectomy should be investigated in future randomized trials.
Mots-clé
stroke, thrombectomy
Pubmed
Open Access
Oui
Création de la notice
18/12/2020 10:18
Dernière modification de la notice
23/12/2020 7:24
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