Outcomes after reperfusion therapies in patients with ACA stroke: A multicenter cohort study from the EVATRISP collaboration

A Filioglo; N Simaan; A Honig; M R Heldner; R von Rennenberg; A Pezzini; V Padjen; A Rentzos; V L Altersberger; P Baumgartner; A Zini; I Grisendi; S Aladdin; J M Gomori; S M Pilgram-Pastor; J F Scheitz; M Magoni; I Berisavac; A Nordanstig; M Psychogios; A Luft; M Gentile; F Assenza; M Arnold; C H Nolte; M Gamba; M Ercegovac; K Jood; S T Engelter; S Wegener; S Forlivesi; M Zedde; H Gensicke; T Tatlisumak; J E Cohen; R R Leker

doi:10.1016/j.jns.2021.120081

Outcomes after reperfusion therapies in patients with ACA stroke: A multicenter cohort study from the EVATRISP collaboration

J Neurol Sci. 2022 Jan 15:432:120081. doi: 10.1016/j.jns.2021.120081. Epub 2021 Dec 11.

Authors

A Filioglo¹, N Simaan¹, A Honig¹, M R Heldner², R von Rennenberg³, A Pezzini⁴, V Padjen⁵, A Rentzos⁶, V L Altersberger⁷, P Baumgartner⁸, A Zini⁹, I Grisendi¹⁰, S Aladdin¹, J M Gomori¹¹, S M Pilgram-Pastor¹², J F Scheitz³, M Magoni¹³, I Berisavac⁵, A Nordanstig¹⁴, M Psychogios¹⁵, A Luft⁸, M Gentile⁹, F Assenza¹⁰, M Arnold², C H Nolte¹⁶, M Gamba¹², M Ercegovac⁵, K Jood¹⁴, S T Engelter¹⁷, S Wegener⁸, S Forlivesi⁹, M Zedde¹⁰, H Gensicke¹⁷, T Tatlisumak¹⁴, J E Cohen¹⁸, R R Leker¹⁹

Affiliations

¹ Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
² Department of Neurology, University Hospital Bern, Switzerland.
³ Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
⁴ Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy.
⁵ Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
⁶ Department of Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital and Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden.
⁷ Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland.
⁸ University Hospital Zurich and University of Zurich, Switzerland.
⁹ IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy.
¹⁰ Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
¹¹ Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
¹² University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
¹³ U.O Vascular Neurology, Stroke Unit, ASST Spedali Civili, Brescia, Italy.
¹⁴ Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹⁵ Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland.
¹⁶ Department of Neurology, Charité-Universitätsmedizin Berlin, Center for Stroke Research, Berlin, Berlin Institute of Health, Berlin, Germany.
¹⁷ Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland.
¹⁸ Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
¹⁹ Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: leker@hadassah.org.il.

PMID: 34920158
DOI: 10.1016/j.jns.2021.120081

Abstract

Background: Patients with stroke secondary to occlusions of the anterior cerebral artery (ACA) often have poor outcomes. The optimal acute therapeutic intervention for these patients remains unknown.

Methods: Patients with isolated ACA-stroke were identified from 10 centers participating in the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) prospective registry. Patients treated with endovascular thrombectomy (EVT) were compared to those treated with intravenous thrombolysis (IVT). Odds ratios with 95% confidence intervals (OR; 95%CI) were calculated using multivariate regression analysis.

Results: Included were 92 patients with ACA-stroke. Of the 92 ACA patients, 55 (60%) were treated with IVT only and 37 (40%) with EVT (±bridging IVT). ACA patients treated with EVT had more often wake-up stroke (24% vs. 6%, p = 0.044) and proximal ACA occlusions (43% vs. 24%, p = 0.047) and tended to have higher stroke severity on admission [NIHSS: 10.0 vs 7.0, p = 0.054). However, odds for favorable outcome, mortality or symptomatic intracranial hemorrhage did not differ significantly between both groups. Exploration of the effect of clot location inside the ACA showed that in patients with A1 or A2/A3 ACA occlusions the chances of favorable outcome were not influenced by treatment allocation to IVT or EVT.

Discussion: Treatment with either IVT or EVT could be safe with similar effect in patients with ACA-strokes and these effects may be independent of clot location within the occluded ACA.

Keywords: Anterior cerebral artery; Cerebrovascular disease; Endovascular; Stroke; Thrombectomy.

Publication types

Multicenter Study

MeSH terms

Brain Ischemia* / complications
Brain Ischemia* / drug therapy
Cohort Studies
Endovascular Procedures*
Fibrinolytic Agents / therapeutic use
Humans
Reperfusion
Stroke* / drug therapy
Thrombectomy
Thrombolytic Therapy
Treatment Outcome

Substances

Fibrinolytic Agents