Thrombectomy vs medical management in low NIHSS acute anterior circulation stroke

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00216208%3A11110%2F20%3A10415902" target="_blank" >RIV/00216208:11110/20:10415902 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216224:14110/20:00118138 RIV/00216208:11130/20:10415902 RIV/00216208:11140/20:10415902 RIV/65269705:_____/20:00074044 a 7 dalších

Výsledek na webu

<a href="https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=NBRZ9KOKfo" target="_blank" >https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=NBRZ9KOKfo</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1212/WNL.0000000000010955" target="_blank" >10.1212/WNL.0000000000010955</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Thrombectomy vs medical management in low NIHSS acute anterior circulation stroke

Popis výsledku v původním jazyce

BACKGROUND: Endovascular thrombectomy (EVT) is highly effective for acute ischemic stroke with large vessel occlusion (LVO) and moderate to severe neurologic deficits. OBJECTIVE: To undertake an effectiveness and safety analysis of EVT in patients with LVO and NIHSS &lt;=6 using datasets of multicentre and multinational nature. METHODS: We pooled patients with anterior circulation occlusion from 3 prospective international cohorts. Patients were eligible if presentation occurred within 12 hours from last known well and baseline NIHSS &lt;=6. Primary outcome was mRS 0-1 at 90 days. Secondary outcomes included neurologic deterioration at 24 hours (change in NIHSS of &gt;=2 points), mRS 0-2 at 90-day and 90-day all-cause mortality. We used propensity score matching to adjust for non-randomized treatment allocation. RESULTS: Among 236 patients who fit inclusion criteria, 139 received EVT and 97 received medical management. Compared to medical management, the EVT group was younger (65 vs 72 years; p &lt; 0.001), had more proximal occlusions (p &lt; 0.001), and less frequently received concurrent intravenous thrombolysis (57.7% vs 71.2%; p = 0.04). After propensity score matching, clinical outcomes between the 2 groups were not significantly different. EVT patients had an 8.6% (95% CI: -8.8% to 26.1%) higher rate of excellent 90-day outcome, despite a 22.3% (95% CI: 3.0%-41.6%) higher risk of neurologic deterioration at 24 hours. CONCLUSIONS: EVT for LVO in patients with low NIHSS was associated with increased risk of neurologic deterioration at 24 hours. However, both EVT and medical management resulted in similar proportions of excellent clinical outcomes at 90 days.

Název v anglickém jazyce

Thrombectomy vs medical management in low NIHSS acute anterior circulation stroke

Popis výsledku anglicky

BACKGROUND: Endovascular thrombectomy (EVT) is highly effective for acute ischemic stroke with large vessel occlusion (LVO) and moderate to severe neurologic deficits. OBJECTIVE: To undertake an effectiveness and safety analysis of EVT in patients with LVO and NIHSS &lt;=6 using datasets of multicentre and multinational nature. METHODS: We pooled patients with anterior circulation occlusion from 3 prospective international cohorts. Patients were eligible if presentation occurred within 12 hours from last known well and baseline NIHSS &lt;=6. Primary outcome was mRS 0-1 at 90 days. Secondary outcomes included neurologic deterioration at 24 hours (change in NIHSS of &gt;=2 points), mRS 0-2 at 90-day and 90-day all-cause mortality. We used propensity score matching to adjust for non-randomized treatment allocation. RESULTS: Among 236 patients who fit inclusion criteria, 139 received EVT and 97 received medical management. Compared to medical management, the EVT group was younger (65 vs 72 years; p &lt; 0.001), had more proximal occlusions (p &lt; 0.001), and less frequently received concurrent intravenous thrombolysis (57.7% vs 71.2%; p = 0.04). After propensity score matching, clinical outcomes between the 2 groups were not significantly different. EVT patients had an 8.6% (95% CI: -8.8% to 26.1%) higher rate of excellent 90-day outcome, despite a 22.3% (95% CI: 3.0%-41.6%) higher risk of neurologic deterioration at 24 hours. CONCLUSIONS: EVT for LVO in patients with low NIHSS was associated with increased risk of neurologic deterioration at 24 hours. However, both EVT and medical management resulted in similar proportions of excellent clinical outcomes at 90 days.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30103 - Neurosciences (including psychophysiology)

Projekt

—

Návaznosti

V - Vyzkumna aktivita podporovana z jinych verejnych zdroju

Rok uplatnění

2020

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Neurology

ISSN

0028-3878

e-ISSN

—

Svazek periodika

95

Číslo periodika v rámci svazku

24

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

9

Strana od-do

"e3364"-"e3372"

Kód UT WoS článku

000607315800032

EID výsledku v databázi Scopus

2-s2.0-85098531606