Journal article
Endovascular Thrombectomy With and Without Preceding Thrombolysis in Posterior Circulation Stroke—Insights From STAR
Stroke: vascular and interventional neurology, Vol.4(5), e001334
09/2024
DOI: 10.1161/SVIN.124.001334
PMCID: PMC12778559
PMID: 41586281
Abstract
BACKGROUND Multiple randomized trials could not establish the noninferiority of endovascular thrombectomy (EVT) alone without preceding intravenous thrombolysis (IVT) or superiority of IVT followed by EVT in anterior circulation large‐vessel occlusion stroke. The role of prior IVT in posterior circulation large‐vessel occlusion remains controversial. METHODS In this multicenter, retrospective study, patients with stroke with large‐vessel occlusion in the posterior circulation who received EVT alone or with IVT were selected from the stroke thrombectomy and aneurysm registry between 2013 and 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. CONCLUSION Similar functional outcomes and complication rates were seen in patients with posterior circulation large‐vessel occlusion treated with EVT alone versus 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.
Details
- Title: Subtitle
- Endovascular Thrombectomy With and Without Preceding Thrombolysis in Posterior Circulation Stroke—Insights From STAR
- Creators
- Ev‐Christin Heide - Universitätsmedizin GöttingenSami Al Kasab - Medical University of South CarolinaAli Alawieh - Emory UniversityAdam Arthur - University of Tennessee Health Science CenterWaleed Brinjikji - Mayo Clinic in ArizonaShakeel Chowdhry - NorthShore University HealthSystemRoberto Crosa - Department of Neurosurgery Endovascular Neurological Center Montevideo UruguayHugo Cuellar - Louisiana State University Health Sciences Center ShreveportReade De Leacy - Mount Sinai Health SystemTravis Dumont - University of ArizonaMarielle Ernst - Universitätsmedizin GöttingenMohamad Ezzeldin - University of HoustonIsabel Fragata - Unidade Local de Saúde de São JoséBrian Howard - Emory UniversityPascal Jabbour - Jefferson University HospitalsPeter Kan - The University of Texas Medical Branch at GalvestonJoon‐Tae Kim - Chonnam National University HospitalMichael R. Levitt - University of WashingtonJustin Mascitelli - The University of Texas at San Antonio Health Science CenterCharles Matouk - Yale UniversityMark Moss - Washington Regional Medical CenterPedro Navia - Hospital Universitario La PazJoshua Osbun - Washington University in St. LouisMin S. Park - University of VirginiaAdam Polifka - University of FloridaMarios‐Nikos Psychogios - University of BaselAnsaar Rai - West Virginia UniversityDaniele G. Romano - University of SienaAmir Shaban - University of IowaRobert M. Starke - University of Miami Health SystemOmar Tanweer - Baylor College of MedicineRichard Williamson - Allegheny Health NetworkStacey Q. Wolfe - Wake Forest UniversityShinichi Yoshimura - Hyogo Medical UniversityAlejandro M. Spiotta - Medical University of South CarolinaIlko L. Maier - Universitätsmedizin GöttingenSTAR Investigators
- Resource Type
- Journal article
- Publication Details
- Stroke: vascular and interventional neurology, Vol.4(5), e001334
- DOI
- 10.1161/SVIN.124.001334
- PMID
- 41586281
- PMCID
- PMC12778559
- NLM abbreviation
- Stroke Vasc Interv Neurol
- ISSN
- 2694-5746
- eISSN
- 2694-5746
- Publisher
- WILEY
- Grant note
None.
- Language
- English
- Electronic publication date
- 07/16/2024
- Date published
- 09/2024
- Academic Unit
- Neurology
- Record Identifier
- 9984658350702771
Metrics
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