Endovascular Thrombectomy With and Without Preceding Thrombolysis in Posterior Circulation Stroke—Insights From STAR
Year: 2024
Type: article
Study design: Observational Study
Abstract: Background Multiple randomized trials could not establish the non-inferiority of endovascular thrombectomy (EVT) alone without preceding intravenous thrombolysis (IVT) or superiority of IVT followed by EVT in anterior circulation large vessel occlusion (LVO) stroke. The role of prior IVT in posterior circulation LVO remains controversial. Methods In this multicenter, retrospective study, stroke patients with LVO in the posterior circulation who received EVT alone or with IVT were selected from the stroke thrombectomy and aneurysm registry (STAR) between 2013 to 2022. Effects of IVT followed by thrombectomy on favorable functional outcome (defined as modified Rankin scale ≤ 3 at 90 days) and safety were investigated using multivariable logistic and linear regression models. Results Of the 588 included patients, 67 % (n = 394) were treated with EVT alone and 29% (n = 170) with EVT after IVT and 4% (n = 24) have missing values on this variable. Controlling for multiple confounding factors, IVT was not associated with a higher likelihood of favorable functional outcome at 90 days (odds ratio 1.04, 95 % CI 0.52-2.09, p = 0.901). Thrombectomy alone did not show any safety advantages compared with those receiving IVT. Conclusions Similar functional outcomes and complication rates were seen in patients with posterior circulation LVO treated with EVT alone vs EVT after IVT. Further prospective studies are required to determine the utility of IVT in posterior circulation stroke, especially in patients being directly admitted to thrombectomy centers.
Authors: Ev‐Christin Heide, Sami Al Kasab, Ali Alawieh, Adam Arthur, Waleed Brinjikji, Shakeel Chowdhry, Roberto Crosa, Hugo Cuellar, Reade De Leacy, Travis Dumont, Marielle Ernst, Mohamad Ezzeldin, Isabel Fragata, Brian Howard, Pascal Jabbour, Peter Kan, Joon‐Tae Kim, Michael R. Levitt, Justin Mascitelli, Charles Matouk, Mark Moss, Pedro Navia, Joshua Osbun, Min S. Park, Adam Polifka, Marios‐Nikos Psychogios, Ansaar Rai, Daniele G. Romano, Amir Shaban, Robert M. Starke, Omar Tanweer, Richard Williamson, Stacey Q. Wolfe, Shinichi Yoshimura, Alejandro M. Spiotta, Ilko L. Maier, STAR Investigators
Institutions: Universitätsmedizin Göttingen, Medical University of South Carolina, Emory University, University of Tennessee Health Science Center, Mayo Clinic, Endeavor Health, Louisiana State University, Louisiana State University Health Sciences Center Shreveport, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, University of Arizona, University of Houston, Unidade Local de Saúde de São José, Thomas Jefferson University Hospital, The University of Texas Medical Branch at Galveston, Chonnam National University, Chonnam National University Hospital, University of Washington, The University of Texas at San Antonio Health Science Center, Yale University, Washington Regional Medical Center, Hospital Universitario La Paz, Washington University in St. Louis, University of Virginia, University of Florida Health, University of Florida, University of Basel, West Virginia University, West Virginia University Hospitals, University of Siena, University of Iowa Hospitals and Clinics, University of Miami Health System, Baylor College of Medicine, Allegheny Health Network, Wake Forest University Health Sciences, Wake Forest University, Hyogo Medical University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,300
OpenAlex ID: W4400691577