Endovascular therapy of acute vertebrobasilar occlusions: influence of first-line strategy in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry.
[en] [en] BACKGROUND: The choice of the first-line technique in vertebrobasilar occlusions (VBOs) remains challenging. We aimed to report outcomes in a large cohort of patients and to compare the efficacy and safety of contact aspiration (CA) and combined technique (CoT) as a first-line endovascular technique in patients with acute VBOs.
METHODS: We retrospectively analyzed clinical and neuroradiological data of patients with VBOs from the prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and August 2023. The primary outcome was the first pass effect (FPE) rate, whereas modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3 and 2c-3, number of passes, need for rescue strategy, modified Rankin Scale (mRS) 0-2, mortality, and symptomatic intracranial hemorrhage (sICH) were secondary outcomes. We performed univariate and multivariate analyses to investigate differences between the two groups.
RESULTS: Among the 583 included patients (mean age 66.2 years, median National Institutes of Health Stroke Scale (NIHSS) 13, median posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) 8), 393 were treated with CA alone and 190 with CoT. Procedures performed with CA were shorter compared with CoT (28 vs 47 min, P<0.0001); however, no differences were observed in terms of FPE (CA 43.3% vs CoT 38.4%, P=0.99), and successful final recanalization (mTICI 2b-3, CA 92.4% vs CoT 91.8%, P=0.74) did not differ between the two groups. Functional independence and sICH rates were also similar, whereas mortality was significantly lower in the CA group (34.5% vs 42.9%; OR 1.79, 95% CI 1.03 to 3.11).
CONCLUSIONS: We observed no differences in FPE, mTICI 2b-3, sICH, and functional independence between the two study groups. First-line CA was associated with shorter procedures and lower mortality rates than CoT.
Disciplines :
Neurology
Author, co-author :
Bekri, Imen; Department of Neurology, Centre Hospitalier de Versailles, Versailles, Île-de-France, France
Finitsis, Stefanos; Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Central Macedonia, Greece
Pizzuto, Silvia; Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, Île-de-France, France
Maier, Benjamin; Department of Neurology, Saint Anne Hospital Centre, Université Paris Cité, Paris, France ; Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
Piotin, Michel; Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
Eker, Omer F; Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
Marnat, Gaultier ; Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
Sibon, Igor; Department of Neurology, Bordeaux Unviersity Hospital, Bordeaux, France
Dargazanli, Cyril ; Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, Occitanie, France
Bourcier, Romain; Neuroradiology, Université de Nantes, CHU Nantes, Neuroradiologie Diagnostique et Interventionnelle, Institut du thorax, Nantes, France
Lapergue, Bertrand; Department of Neurology and Stroke Center, Hospital Foch, Suresnes, Île-de-France, France
Pop, Raoul ; Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France
Caroff, Jildaz ; Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
Gory, Benjamin; Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
Pico, Fernando; Department of Vascular Neurology, Centre Hospitalier de Versailles, Versailles, France
Consoli, Arturo ; Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, Île-de-France, France onemed21@gmail.com ; UFR Simon Veil Santé, University of Versailles Saint-Quentine-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques
Language :
English
Title :
Endovascular therapy of acute vertebrobasilar occlusions: influence of first-line strategy in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry.
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