Endovascular thrombectomy versus medical management for moderate-to-severe anterior cerebral artery occlusion stroke.

Publisher: Springer-Verlag Country of Publication: Germany NLM ID: 0423161 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1459 (Electronic) Linking ISSN: 03405354 NLM ISO Abbreviation: J Neurol Subsets: MEDLINE

Original Publication: Berlin ; New York, Springer-Verlag

Endovascular Procedures* ; Thrombectomy*/statistics & numerical data ; Thrombectomy*/methods; Humans ; Male ; Female ; Aged ; Retrospective Studies ; Middle Aged ; Aged, 80 and over ; Infarction, Anterior Cerebral Artery/surgery ; Ischemic Stroke/therapy ; Ischemic Stroke/surgery ; Severity of Illness Index

Background: There are no established patient selection criteria for endovascular thrombectomy (EVT) for anterior cerebral artery (ACA) stroke.
Methods: This was a retrospective cohort study of the 2016-2020 National Inpatient Sample in the United States. Isolated ACA-occlusion stroke patients with moderate-to-severe stroke symptoms (NIH stroke scale [NIHSS] ≥ 6) were included. Primary outcome was hospital discharge to home with self-care. Secondary outcomes include in-hospital mortality and intracranial hemorrhage (ICH). Confounders were accounted for by multivariable logistic regression.
Results: 6685 patients were included; 335 received EVT. Compared to medical management (MM), EVT patients were younger (mean 67.2 versus 72.2 years; p = 0.014) and had higher NIHSS (mean 16.0 versus 12.5; p < 0.001). EVT was numerically but not statistically significantly associated with higher odds of home discharge compared to MM (aOR 2.26 [95%CI 0.99-5.17], p = 0.053). EVT was significantly associated with higher odds of home discharge among patients with NIHSS 10 or greater (aOR 3.35 [95%CI 1.06-10.58], p = 0.039), those who did not receive prior thrombolysis (aOR 3.96 [95%CI 1.53-10.23], p = 0.005), and those with embolic stroke etiology (aOR 4.03 [95%CI 1.21-13.47], p = 0.024). EVT was not significantly associated with higher rates of mortality (aOR 1.93 [95%CI 0.80-4.63], p = 0.14); however, it was significantly associated with higher rates of ICH (22.4% vs. 8.5%, p < 0.001).
Conclusion: EVT was associated with higher odds of favorable short-term outcomes for moderate-to-severe ACA-occlusion stroke in select patients. Future studies are needed to confirm the efficacy of EVT in terms of longer term neurological outcomes.
(© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

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Keywords: Anterior cerebral artery; Hemorrhage; Stroke; Thrombectomy; Thrombolysis

Date Created: 20240731 Date Completed: 20240905 Latest Revision: 20240905

20240905

10.1007/s00415-024-12582-z

39085619