Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2020-07-25

AUTHORS

Manuel Cappellari, Giovanni Pracucci, Stefano Forlivesi, Valentina Saia, Nicola Limbucci, Patrizia Nencini, Domenico Inzitari, Valerio Da Ros, Fabrizio Sallustio, Stefano Vallone, Guido Bigliardi, Andrea Zini, Sergio Lucio Vinci, Cristina Dell’Aera, Sandra Bracco, Samuele Cioni, Rossana Tassi, Mauro Bergui, Andrea Naldi, Giuseppe Carità, Cristiano Azzini, Ilaria Casetta, Roberto Gasparotti, Mauro Magoni, Lucio Castellan, Cinzia Finocchi, Roberto Menozzi, Umberto Scoditti, Francesco Causin, Federica Viaro, Edoardo Puglielli, Alfonsina Casalena, Maria Ruggiero, Sara Biguzzi, Davide Castellano, Roberto Cavallo, Guido Andrea Lazzarotti, Giovanni Orlandi, Alessandro Sgreccia, Maria Federica Denaro, Nicola Cavasin, Adriana Critelli, Elisa Francesca Maria Ciceri, Bruno Bonetti, Luigi Chiumarulo, Marco Petruzzelli, Carlo Pellegrino, Federico Carimati, Nicola Burdi, Maria Pia Prontera, Wiliam Auteri, Alfredo Petrone, Giulio Guidetti, Ettore Nicolini, Giuseppe Ganci, Annalisa Sugo, Pietro Filauri, Simona Sacco, Guido Squassina, Paolo Invernizzi, Nunzio Paolo Nuzzi, Manuel Corato, Pietro Amistà, Mauro Gentile, Stefano Barbero, Federica Schirru, Giuseppe Craparo, Marina Mannino, Luigi Simonetti, Salvatore Mangiafico, Danilo Toni

ABSTRACT

BackgroundIntravenous thrombolysis (IVT)-ineligible patients undergoing direct thrombectomy tended to have poorer functional outcome as compared with IVT-eligible patients undergoing bridging therapy. We aimed to assess radiological and functional outcomes in large vessel occlusion-related stroke patients receiving direct thrombectomy in the presence of absolute exclusion criteria for IVT vs relative exclusion criteria for IVT and vs non-exclusion criteria for IVT.MethodsA cohort study on prospectively collected data from 2282 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke cohort for treatment with direct thrombectomy (n = 486, absolute exclusion criteria for IVT alone; n = 384, absolute in combination with relative exclusion criteria for IVT; n = 777, relative exclusion criteria for IVT alone; n = 635, non-exclusion criteria for IVT).ResultsAfter adjustment for unbalanced variables (model 1), ORs for 3-month death was higher in the presence of absolute exclusion criteria for IVT alone (vs relative exclusion criteria for IVT alone) (1.595, 95% CI 1.042–2.440) and in the presence of absolute exclusion criteria for IVT alone (vs non-exclusion criteria for IVT) (1.235, 95% CI 1.014–1.504). After adjustment for predefined variables (model 2: age, sex, pre-stroke mRS ≤ 1, NIHSS, occlusion in the anterior circulation, onset-to-groin time, and procedure time), ORs for 3-month death was higher in the presence of absolute exclusion criteria for IVT alone (vs relative exclusion criteria for IVT alone) (1.235, 95% CI 1.014–1.504) and in the presence of absolute exclusion criteria for IVT alone (vs non-exclusion criteria for IVT) (1.246, 95% CI 1.039–1.495). No significant difference was found between the groups as regards any type of intracerebral hemorrhage and parenchymal hematoma within 24 h, successful and complete recanalization after procedure, and modified Rankin Scale score 0–2 at 3 months. After adjustment for predefined variables of model 2, ORs for death were higher in the presence of recent administration of IV heparin (OR: 2.077), platelet count < 100,000/mm3 (OR: 4.798), bacterial endocarditis (OR: 15.069), neoplasm with increased hemorrhagic risk (OR: 6.046), and severe liver disease (OR: 6.124).ConclusionsRadiological outcomes were similar after direct thrombectomy in patients with absolute, relative, and non- exclusion criteria for IVT, while an increase of fatal outcome was observed in the presence of some absolute exclusion criterion for IVT. More... »

PAGES

3731-3740

Journal

TITLE

Journal of Neurology

ISSUE

12

VOLUME

267

Author Affiliations

  • USD Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy
  • University of Florence, Firenze, Italy
  • IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
  • Santa Corona Hospital, Pietra Ligure, Italy
  • Careggi University Hospital, Firenze, Italy
  • Policlinico Tor Vergata, Rome, Italy
  • Ospedale Civile S.Agostino-Estense-University Hospital, Modena, Italy
  • Policlinico G. Martino, Messina, Italy
  • Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
  • Città della Salute e della Scienza-Molinette, Turin, Italy
  • Arcispedale S. Anna-University Hospital, Ferrara, Italy
  • Spedali Civili, Brescia, Italy
  • IRCCS San Martino-IST, Genoa, Italy
  • Ospedale Universitario, Parma, Italy
  • Azienda Ospedaliero-Univeristaria, Padua, Italy
  • Ospedale Civile Mazzini, Teramo, Italy
  • Ospedale M. Bufalini, Cesena, Italy
  • Ospedale San Giovanni Bosco, Turin, Italy
  • Ospedale Cisanello, Pisa, Italy
  • Policlinico IRCCS San Matteo, Pavia, Italy
  • IRCCS Mondino Foundation, Pavia, Italy
  • Ospedale dell’Angelo-USSL3 Serenissima, Mestre, Italy
  • Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • Azienda Ospedaliera Universitaria-Policlinico, Bari, Italy
  • Ospedale Universitario Circolo-ASST Sette Laghi, Varese, Italy
  • Ospedale SS. Annunziata, Taranto, Italy
  • Azienda Ospedaliera Annunziata, Cosenza, Italy
  • Sapienza University Hospital, Rome, Italy
  • Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
  • Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
  • Humanitas Research Hospital, Rozzano, Italy
  • Ospedale S. Maria Misericordia, Rovigo, Italy
  • AO SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy
  • Ospedale S. Michele-AO Brotzu, Cagliari, Italy
  • Ospedale Civico-A.R.N.A.S., Palermo, Italy
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00415-020-10098-w

    DOI

    http://dx.doi.org/10.1007/s00415-020-10098-w

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1129660627

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/32712865


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