Steffen Tiedt (Germany)
LMU Munich Institute for Stroke and Dementia ResearchAuthor Of 2 Presentations
MECHANICAL THROMBECTOMY FOR BASILAR ARTERY OCCLUSION STROKE: ANALYSIS OF THE GERMAN STROKE REGISTRY-ENDOVASCULAR TREATMENT (GSR-ET)
Abstract
Background and Aims
Stroke due to basilar artery occlusion (BAO) causes the most severe strokes with poor prognosis. Data regarding efficacy of mechanical thrombectomy (MT) in BAO are sparse.
Methods
Patients enrolled between 06/2015 and 12/2019 in the German Stroke Registry-Endovascular Treatment (GSR-ET) were analyzed. The GSR-ET is an independent, prospective, multicenter, observational registry with 25 participating stroke centers in Germany enrolling patients treated with MT. Primary outcomes were successful reperfusion (mTICI score of 2b-3) and good functional outcome at 3-months (mRS of 0-2).
Results
640 (9.6%) of the 6635 patients in the GSR were strokes due to BAO. Successful reperfusion was observed in 86.6%. At 3 months follow-up, 31% of patients showed a good functional outcome, mortality was 39%. Analysis of mTICI3 vs. mTICI2b showed considerable better outcomes (good outcome in 38.9% vs. 24.4% p=0.005, see Figure 1). Strongest predictor for good functional outcome were IVT treatment (OR 3.04, 95% CI 1.76-5.23) and successful reperfusion (OR 4.92, 95% CI 1.15-21.11), while the effect of the time between symptom onset and start of reperfusion seems to be low (see Figure 2).
Conclusions
Acute reperfusion strategies of BAO are common in daily practice and can be performed safely with high rates of successful reperfusion. Our data suggest that successful, and especially complete reperfusion predicts good outcome, while the time since symptom onset has a low impact. That reinforces the importance of reperfusion success in acute BAO. Future clinical trials should address acute reperfusion strategies of BAO patients.
MINOR STROKES WITH LARGE VESSEL OCCLUSION: A MATCHED ANALYSIS FROM THE GERMAN STROKE REGISTRY-ENDOVASCULAR TREATMENT(GSR-ET) AND THE SAFE IMPLEMENTATION OF THROMBOLYSIS IN STROKE REGISTRY (SITS)
Abstract
Background and Aims
Treatment of large vessel occlusion (LVO) in patients presenting with mild neurological deficits (minor strokes with NIHSS ≤ 5) is still a matter of debate. The main purpose of this study was to compare the outcome of LVO-minor stroke patients treated with intravenous thrombolysis(IVT) plus/minus mechanical thrombectomy(MT).
Methods
GSR-ET and SITS-registry patients enrolled between 06/2015 and 12/2019 were analyzed. Minor stroke patients due to LVO were compared using propensity score matching (PSM). Primary outcomes were the safety, technical and clinical efficacy of IVT plus/minus MT including the technical angiographic outcome parameters (successful reperfusion using the modified Thrombolysis In Cerebral Infarction (mTICI) score of 2b-3) and good functional outcome at 3-months follow-up (modified Rankin Scale (mRS) of 0-2).
Results
Among 6635 GSR-patients, a total of 676 (9.6%) presented with minor strokes. Among these, 272GSR-ET-patients – all IVT-treated (age 68.6±14.0 years, 43.4%female, premorbid mRS (pmRS) 0 (0-0), NIHSS 4 (2-5)) were compared to 272 SITS-patients(69.4±13.7, 43.4% female, pmRS 0 (0-0), NIHSS 4 (2-5)). Successful reperfusion in GSR-ET-patients was achieved in 81.6%. Good functional outcome (67.3% versus 69.5%, p=0.795), mortality (5.1% versus 6.6%, p=0.207) and intracranial hemorrhage (12.5% versus 8.8%, p=0.308) were comparable. After PSM for 624 GSR-ET-patients (IVT-rate 56.7%) and 624 SITS-patients (IVT-rate 100%) independent predictors for good outcome were age, pmRS, NIHSS, IVT-treatment and occurrence of ICH.
Conclusions
Our study demonstrates similar effectiveness of IVT alone compared to MT plus/minus IVT in minor stroke patients. There is an urgent need for randomized controlled trials in this stroke field, including imaging parameters.