J Stroke.  2021 Sep;23(3):388-400. 10.5853/jos.2021.00850.

Stroke Etiology and Outcomes after Endovascular Thrombectomy: Results from the SITS Registry and a Meta-Analysis

Affiliations
  • 1Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
  • 2Department of Research and Education, Karolinska University Hospital, Stockholm, Sweden
  • 3Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
  • 4Department of Neurology, North Estonia Medical Centre Foundation, Tallinn, Estonia
  • 5Stroke Unit, Saint Joseph's Hospital, Central Lisbon University Hospital Centre, Lisbon, Portugal
  • 6Stroke Unit, University Hospital of Siena, Siena, Italy
  • 7Stroke Unit, Department of Neurology, San Carlos Clinical Hospital, Madrid, Spain
  • 8Stroke Unit, Tampere University Hospital, Tampere, Finland
  • 9Department of Neuroscience, Neurologal Clinic, Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
  • 10Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden

Abstract

Background and Purpose
The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT.
Methods
We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0–2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447).
Results
Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. Conclusions From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference between etiologies with aggregate data.

Keyword

Ischemic stroke; Embolic stroke; Thrombotic stroke; Thrombectomy; Meta-analysis; Review
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