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Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage

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Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage. / Meyer, Lukas; Bechstein, Matthias; Bester, Maxim; Hanning, Uta; Brekenfeld, Caspar; Flottmann, Fabian; Kniep, Helge; van Horn, Noel; Deb-Chatterji, Milani; Thomalla, Götz; Sporns, Peter; Yeo, Leonard Leong-Litt; Tan, Benjamin Yong-Qiang; Gopinathan, Anil; Kastrup, Andreas; Politi, Maria; Papanagiotou, Panagiotis; Kemmling, André; Fiehler, Jens; Broocks, Gabriel; German Stroke Registry – Endovascular Treatment (GSR – ET).

in: STROKE, Jahrgang 52, Nr. 10, 10.2021, S. 3109-3117.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Meyer, L, Bechstein, M, Bester, M, Hanning, U, Brekenfeld, C, Flottmann, F, Kniep, H, van Horn, N, Deb-Chatterji, M, Thomalla, G, Sporns, P, Yeo, LL-L, Tan, BY-Q, Gopinathan, A, Kastrup, A, Politi, M, Papanagiotou, P, Kemmling, A, Fiehler, J, Broocks, G & German Stroke Registry – Endovascular Treatment (GSR – ET) 2021, 'Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage', STROKE, Jg. 52, Nr. 10, S. 3109-3117. https://doi.org/10.1161/STROKEAHA.120.033101

APA

Meyer, L., Bechstein, M., Bester, M., Hanning, U., Brekenfeld, C., Flottmann, F., Kniep, H., van Horn, N., Deb-Chatterji, M., Thomalla, G., Sporns, P., Yeo, L. L-L., Tan, B. Y-Q., Gopinathan, A., Kastrup, A., Politi, M., Papanagiotou, P., Kemmling, A., Fiehler, J., ... German Stroke Registry – Endovascular Treatment (GSR – ET) (2021). Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage. STROKE, 52(10), 3109-3117. https://doi.org/10.1161/STROKEAHA.120.033101

Vancouver

Meyer L, Bechstein M, Bester M, Hanning U, Brekenfeld C, Flottmann F et al. Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage. STROKE. 2021 Okt;52(10):3109-3117. https://doi.org/10.1161/STROKEAHA.120.033101

Bibtex

@article{bca4a32017694f7b8dc33884df602404,
title = "Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage",
abstract = "Background and Purpose: This study evaluates the benefit of endovascular treatment (EVT) for patients with extensive baseline stroke compared with best medical treatment.Methods: This retrospective, multicenter study compares EVT and best medical treatment for computed tomography (CT)–based selection of patients with extensive baseline infarcts (Alberta Stroke Program Early CT Score ≤5) attributed to anterior circulation stroke. Patients were selected from the German Stroke Registry and 3 tertiary stroke centers. Primary functional end points were rates of good (modified Rankin Scale score of ≤3) and very poor outcome (modified Rankin Scale score of ≥5) at 90 days. Secondary safety end point was the occurrence of symptomatic intracerebral hemorrhage. Angiographic outcome was evaluated with the modified Thrombolysis in Cerebral Infarction Scale.Results: After 1:1 pair matching, a total of 248 patients were compared by treatment arm. Good functional outcome was observed in 27.4% in the EVT group, and in 25% in the best medical treatment group (P=0.665). Advanced age (adjusted odds ratio, 1.08 [95% CI, 1.05–1.10], P<0.001) and symptomatic intracerebral hemorrhage (adjusted odds ratio, 6.35 [95% CI, 2.08–19.35], P<0.001) were independently associated with very poor outcome. Mortality (43.5% versus 28.9%, P=0.025) and symptomatic intracerebral hemorrhage (16.1% versus 5.6%, P=0.008) were significantly higher in the EVT group. The lowest rates of good functional outcome (≈15%) were observed in groups of failed and partial recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 0/1–2a), whereas patients with complete recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 3) with recanalization attempts ≤2 benefitted the most (modified Rankin Scale score of ≤3:42.3%, P=0.074) compared with best medical treatment.Conclusions: In daily clinical practice, EVT for CT–based selected patients with low Alberta Stroke Program Early CT Score anterior circulation stroke may not be beneficial and is associated with increased risk for hemorrhage and mortality, especially in the elderly. However, first- or second-pass complete recanalization seems to reveal a clinical benefit of EVT highlighting the vulnerability of the low Alberta Stroke Program Early CT Score subgroup.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03356392.",
author = "Lukas Meyer and Matthias Bechstein and Maxim Bester and Uta Hanning and Caspar Brekenfeld and Fabian Flottmann and Helge Kniep and {van Horn}, Noel and Milani Deb-Chatterji and G{\"o}tz Thomalla and Peter Sporns and Yeo, {Leonard Leong-Litt} and Tan, {Benjamin Yong-Qiang} and Anil Gopinathan and Andreas Kastrup and Maria Politi and Panagiotis Papanagiotou and Andr{\'e} Kemmling and Jens Fiehler and Gabriel Broocks and {German Stroke Registry – Endovascular Treatment (GSR – ET)}",
year = "2021",
month = oct,
doi = "10.1161/STROKEAHA.120.033101",
language = "English",
volume = "52",
pages = "3109--3117",
journal = "STROKE",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

RIS

TY - JOUR

T1 - Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage

AU - Meyer, Lukas

AU - Bechstein, Matthias

AU - Bester, Maxim

AU - Hanning, Uta

AU - Brekenfeld, Caspar

AU - Flottmann, Fabian

AU - Kniep, Helge

AU - van Horn, Noel

AU - Deb-Chatterji, Milani

AU - Thomalla, Götz

AU - Sporns, Peter

AU - Yeo, Leonard Leong-Litt

AU - Tan, Benjamin Yong-Qiang

AU - Gopinathan, Anil

AU - Kastrup, Andreas

AU - Politi, Maria

AU - Papanagiotou, Panagiotis

AU - Kemmling, André

AU - Fiehler, Jens

AU - Broocks, Gabriel

AU - German Stroke Registry – Endovascular Treatment (GSR – ET)

PY - 2021/10

Y1 - 2021/10

N2 - Background and Purpose: This study evaluates the benefit of endovascular treatment (EVT) for patients with extensive baseline stroke compared with best medical treatment.Methods: This retrospective, multicenter study compares EVT and best medical treatment for computed tomography (CT)–based selection of patients with extensive baseline infarcts (Alberta Stroke Program Early CT Score ≤5) attributed to anterior circulation stroke. Patients were selected from the German Stroke Registry and 3 tertiary stroke centers. Primary functional end points were rates of good (modified Rankin Scale score of ≤3) and very poor outcome (modified Rankin Scale score of ≥5) at 90 days. Secondary safety end point was the occurrence of symptomatic intracerebral hemorrhage. Angiographic outcome was evaluated with the modified Thrombolysis in Cerebral Infarction Scale.Results: After 1:1 pair matching, a total of 248 patients were compared by treatment arm. Good functional outcome was observed in 27.4% in the EVT group, and in 25% in the best medical treatment group (P=0.665). Advanced age (adjusted odds ratio, 1.08 [95% CI, 1.05–1.10], P<0.001) and symptomatic intracerebral hemorrhage (adjusted odds ratio, 6.35 [95% CI, 2.08–19.35], P<0.001) were independently associated with very poor outcome. Mortality (43.5% versus 28.9%, P=0.025) and symptomatic intracerebral hemorrhage (16.1% versus 5.6%, P=0.008) were significantly higher in the EVT group. The lowest rates of good functional outcome (≈15%) were observed in groups of failed and partial recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 0/1–2a), whereas patients with complete recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 3) with recanalization attempts ≤2 benefitted the most (modified Rankin Scale score of ≤3:42.3%, P=0.074) compared with best medical treatment.Conclusions: In daily clinical practice, EVT for CT–based selected patients with low Alberta Stroke Program Early CT Score anterior circulation stroke may not be beneficial and is associated with increased risk for hemorrhage and mortality, especially in the elderly. However, first- or second-pass complete recanalization seems to reveal a clinical benefit of EVT highlighting the vulnerability of the low Alberta Stroke Program Early CT Score subgroup.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03356392.

AB - Background and Purpose: This study evaluates the benefit of endovascular treatment (EVT) for patients with extensive baseline stroke compared with best medical treatment.Methods: This retrospective, multicenter study compares EVT and best medical treatment for computed tomography (CT)–based selection of patients with extensive baseline infarcts (Alberta Stroke Program Early CT Score ≤5) attributed to anterior circulation stroke. Patients were selected from the German Stroke Registry and 3 tertiary stroke centers. Primary functional end points were rates of good (modified Rankin Scale score of ≤3) and very poor outcome (modified Rankin Scale score of ≥5) at 90 days. Secondary safety end point was the occurrence of symptomatic intracerebral hemorrhage. Angiographic outcome was evaluated with the modified Thrombolysis in Cerebral Infarction Scale.Results: After 1:1 pair matching, a total of 248 patients were compared by treatment arm. Good functional outcome was observed in 27.4% in the EVT group, and in 25% in the best medical treatment group (P=0.665). Advanced age (adjusted odds ratio, 1.08 [95% CI, 1.05–1.10], P<0.001) and symptomatic intracerebral hemorrhage (adjusted odds ratio, 6.35 [95% CI, 2.08–19.35], P<0.001) were independently associated with very poor outcome. Mortality (43.5% versus 28.9%, P=0.025) and symptomatic intracerebral hemorrhage (16.1% versus 5.6%, P=0.008) were significantly higher in the EVT group. The lowest rates of good functional outcome (≈15%) were observed in groups of failed and partial recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 0/1–2a), whereas patients with complete recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 3) with recanalization attempts ≤2 benefitted the most (modified Rankin Scale score of ≤3:42.3%, P=0.074) compared with best medical treatment.Conclusions: In daily clinical practice, EVT for CT–based selected patients with low Alberta Stroke Program Early CT Score anterior circulation stroke may not be beneficial and is associated with increased risk for hemorrhage and mortality, especially in the elderly. However, first- or second-pass complete recanalization seems to reveal a clinical benefit of EVT highlighting the vulnerability of the low Alberta Stroke Program Early CT Score subgroup.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03356392.

U2 - 10.1161/STROKEAHA.120.033101

DO - 10.1161/STROKEAHA.120.033101

M3 - SCORING: Journal article

C2 - 34470489

VL - 52

SP - 3109

EP - 3117

JO - STROKE

JF - STROKE

SN - 0039-2499

IS - 10

ER -