Stroke Etiology Modifies the Effect of Endovascular Treatment in Acute Stroke
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Stroke Etiology Modifies the Effect of Endovascular Treatment in Acute Stroke. / Tiedt, Steffen; Herzberg, Moriz; Küpper, Clemens; Feil, Katharina; Kellert, Lars; Dorn, Franziska; Liebig, Thomas; Alegiani, Anna; Dichgans, Martin; Wollenweber, Frank A; GSR investigators.
in: STROKE, Jahrgang 51, Nr. 3, 03.2020, S. 1014-1016.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Stroke Etiology Modifies the Effect of Endovascular Treatment in Acute Stroke
AU - Tiedt, Steffen
AU - Herzberg, Moriz
AU - Küpper, Clemens
AU - Feil, Katharina
AU - Kellert, Lars
AU - Dorn, Franziska
AU - Liebig, Thomas
AU - Alegiani, Anna
AU - Dichgans, Martin
AU - Wollenweber, Frank A
AU - GSR investigators
AU - Fiehler, Jens
AU - Flottmann, Fabian Alexander
AU - Gerloff, Christian
AU - Thomalla, Götz
PY - 2020/3
Y1 - 2020/3
N2 - Background and Purpose- Stroke etiology drives thrombus composition. We thus hypothesized that endovascular treatment shows different efficacy in cardioembolic versus noncardioembolic large-vessel occlusions (LVOs). Methods- Procedural characteristics, grade of reperfusion, and functional outcome at discharge and 90 days were compared between patients with cardioembolic versus noncardioembolic LVO from the GSR-ET (German Stroke Registry-Endovascular Treatment; n=2589). To determine associations with functional outcome, adjusted odds ratios and 95% CIs were calculated using ordinal multivariable logistic regression models adjusting for potential baseline confounder variables. Results- Endovascular treatment of cardioembolic LVO had a higher rate of successful reperfusion (85.6% versus 81.0%; P=0.002) and a higher rate of complete reperfusion after a single thrombectomy pass (45.7% versus 38.1%; P<0.001) compared with noncardioembolic LVO. Cardioembolic LVO was associated with better functional outcome at discharge (adjusted odds ratio, 1.61 [95% CI, 1.37-1.88]) and 90 days (adjusted odds ratio, 1.29 [95% CI, 1.09-1.53]). In mediation analysis, reperfusion explained 47% of the effect of etiology on functional outcome at discharge. Conclusions- These results provide evidence for higher efficacy of endovascular treatment in cardioembolic LVO compared with noncardioembolic LVO.
AB - Background and Purpose- Stroke etiology drives thrombus composition. We thus hypothesized that endovascular treatment shows different efficacy in cardioembolic versus noncardioembolic large-vessel occlusions (LVOs). Methods- Procedural characteristics, grade of reperfusion, and functional outcome at discharge and 90 days were compared between patients with cardioembolic versus noncardioembolic LVO from the GSR-ET (German Stroke Registry-Endovascular Treatment; n=2589). To determine associations with functional outcome, adjusted odds ratios and 95% CIs were calculated using ordinal multivariable logistic regression models adjusting for potential baseline confounder variables. Results- Endovascular treatment of cardioembolic LVO had a higher rate of successful reperfusion (85.6% versus 81.0%; P=0.002) and a higher rate of complete reperfusion after a single thrombectomy pass (45.7% versus 38.1%; P<0.001) compared with noncardioembolic LVO. Cardioembolic LVO was associated with better functional outcome at discharge (adjusted odds ratio, 1.61 [95% CI, 1.37-1.88]) and 90 days (adjusted odds ratio, 1.29 [95% CI, 1.09-1.53]). In mediation analysis, reperfusion explained 47% of the effect of etiology on functional outcome at discharge. Conclusions- These results provide evidence for higher efficacy of endovascular treatment in cardioembolic LVO compared with noncardioembolic LVO.
KW - Aged
KW - Aged, 80 and over
KW - Endovascular Procedures
KW - Female
KW - Humans
KW - Intracranial Embolism/epidemiology
KW - Male
KW - Middle Aged
KW - Registries
KW - Stroke/epidemiology
KW - Thrombectomy
U2 - 10.1161/STROKEAHA.119.028383
DO - 10.1161/STROKEAHA.119.028383
M3 - SCORING: Journal article
C2 - 31847752
VL - 51
SP - 1014
EP - 1016
JO - STROKE
JF - STROKE
SN - 0039-2499
IS - 3
ER -