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

• Matusevicius M
• Cooray C
• Rand VM
• Nunes AP
• Moreira T
• Tassi R
• Egido JA
• Ollikainen J
• Bigliardi G
• Holmin S
• Ahmed N

• KMID: 2520916
• DOI: http://doi.org/10.5853/jos.2021.00850

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

Figure

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  Figure 1. Study flow chart. SITS, Safe Implementation of Treatment in Stroke; LAA, large artery atherosclerosis; CE, cardiac emboli; ICD-10, International Statistical Classification of Diseases and Related Health Problems version 10.

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  Figure 2. Meta-analysis of included studies for the outcomes, with aggregate, unadjusted data. (A) Modified Treatment in Cerebral Infarction (mTICI) 2b-3, (B) modified Rankin Scale (mRS) 0-2 at 3 months, (C) death by 3 months, and (D) symptomatic intracranial hemorrhage (SICH). LAA, large artery atherosclerosis; CE, cardiac emboli; OR, odds ratio; CI, confidence interval.

Reference

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