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  • Endovascular therapy for acute intracranial large vessel occlusion due to atherothrombosis: Multicenter historical registry

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Ischemic stroke
Original research
Endovascular therapy for acute intracranial large vessel occlusion due to atherothrombosis: Multicenter historical registry
  1. Kazutaka Uchida1,
  2. Hiroshi Yamagami2,
  3. Nobuyuki Sakai3,
  4. Manabu Shirakawa1,
  5. Mikiya Beppu1,
  6. Kazunori Toyoda4,
  7. Yuji Matsumaru5,
  8. Yasushi Matsumoto6,
  9. Kenichi Todo7,
  10. Mikito Hayakawa5,
  11. Seigo Shindo8,9,
  12. Shinzo Ota10,
  13. Masafumi Morimoto11,
  14. Masataka Takeuchi12,
  15. Hirotoshi Imamura13,
  16. Hiroyuki Ikeda14,
  17. Kanta Tanaka15,
  18. Hideyuki Ishihara16,
  19. Hiroto Kakita17,
  20. Takanori Sano18,
  21. Hayato Araki19,
  22. Tatsufumi Nomura20,
  23. Fumihiro Sakakibara1,
  24. Shinichi Yoshimura1
  1. 1 Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
  2. 2 Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
  3. 3 Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan
  4. 4 Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
  5. 5 Division of Stroke Prevention and Treatment, Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
  6. 6 Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan
  7. 7 Stroke Center, Osaka University Graduate School of Medicine, Suita, Japan
  8. 8 Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
  9. 9 Department of Neurology, Kumamoto University, Kumamoto, Japan
  10. 10 Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
  11. 11 Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Japan
  12. 12 Department of Neurosurgery, Seisho Hospital, Odawara, Japan
  13. 13 Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
  14. 14 Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
  15. 15 Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
  16. 16 Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan
  17. 17 Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan
  18. 18 Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan
  19. 19 Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
  20. 20 Neuroendovasucular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Japan
  1. Correspondence to Shinichi Yoshimura; hyogoneuro{at}yahoo.co.jp

Abstract

Background Atherothrombotic stroke-related large vessel occlusion (AT-LVO) is caused by two etiologies, the intracranial artery occlusion due to in situ occlusion (intracranial group) or due to embolism from cervical carotid occlusion or stenosis (tandem group). The prognosis and reocclusion rate of each etiology after endovascular therapy (EVT) is unclear.

Methods We conducted a historical multicenter registry study at 51 Japanese centers to compare the prognoses of AT-LVO between two etiologies. The primary outcome was the incidence of recurrent ischemic stroke or reocclusion of the treated vessels within 90 days after EVT. Each of the primary outcome means the incidence of recurrent ischemic stroke and reocclusion of the treated vessels within 90 days after EVT.

Results We analyzed 582 patients (338 in the intracranial group and 244 in the tandem group). Patients in the intracranial group were younger (mean 71.9 vs 74.5, p=0.003), more of them were female and fewer of them were current smokers than those in the tandem group. In the tandem group, the patients’ National Institutes of Health Stroke Scale score on admission was higher (13 vs 15, p=0.006), onset to puncture time was shorter (299 [145–631] vs 232 [144–459] minutes, p=0.03) and Alberta Stroke Program Early CT Score (ASPECTS) was lower (8 [7–9] vs 8 [6–9], p=0.0002). The primary outcome was higher in the intracranial group (22.5% vs 8.2%, p<0.0001). However, any ICH and death were not significantly different in the two groups.

Conclusions The incidence of recurrent ischemic stroke or reocclusion after EVT for AT-LVO was higher in the intracranial group.

  • Stroke
  • Thrombectomy
  • Atherosclerosis

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-020670

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Collaborators the RESCUE AT-LVO Investigators.

    • Contributors Uchida K and Yoshimura S are responsible for the overall content as the guarantor. Study concept and design: Yoshimura S, Yamagami H, Sakai N, Shirakawa M, Beppu M, Todo K, Hayakawa M, Imamura H. Acquisition of data: Shindo S, Ota S, Morimoto M, Takeuchi M, Imamura H, Beppu M, Ikeda H, Tanaka K, Ishihara H, Kakita H, Sano T, Araki H, Nomura T. Statistical analysis: Uchida K, Sakakibara F. Funding: None. Administrative, technical, or material support: Yoshimura S. Study supervision: Yoshimura S, Yamagami H, Sakai N, Toyoda K, Matsumaru Y.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Declaration of interest Dr. Uchida reports lecturer’s fees from Daiichi Sankyo, Bristol-Myers Squibb, Stryker, and Medtronic. Dr. Yamagami discloses research grants from Bristol-Myers Squibb; lecturer’s fees from Stryker, Medtronic, Terumo, Johnson & Johnson, and Medico’s Hirata. Dr Sakai reports a research grant from Biomedical Solutions, Medtronic, Terumo and TG Medical; lecturer’s fees from Asahi-Intec, Biomedical Solutions, Kaneka, Medtronic, and Terumo; membership on the advisory boards for Johnson & Johnson, Medtronic and Terumo. Dr. Shirakawa reports lecturer’s fees from Stryker, Medtronic, Terumo, Johnson & Johnson, Kaneka. Dr. Beppu reports manuscript fees from Medicus Shuppan. Dr. Toyoda reports lecture’s fees from Bayer, Daiichi Sankyo, Otsuka, Novertis, and Bristol Myers Squibb. Dr. Matsumaru reports lecturer fees from Medtronic, Stryker, Terumo, Johnson & Johnson, Kaneka, and Jimro. Dr. Matsumoto reports the lecturer’s fees from Kaneka, Medico’s Hirata, Fuji systems, GE healthcare, Otsuka, Takeda, Century Medical, Terumo, Medtronic, and Stryker. Dr. Todo reports lecture fees from Pfizer, Bristol-Myers Squibb, Daiichi-Sankyo, Bayer, Stryker, Medtronic, AstraZeneca, Otsuka Pharmaceutical, Kyowa Kirin, Takeda Pharmaceutical and Amgen. Dr. Shindo reports lecturer fees from Medtronic, Kaneka, Stryker,Daiichi Sankyo, Asahi-Intec, Ezai, Bayer, Abbot medical, Medicos Hirata and Johnson and Johnson. Dr. Imamura reports the lecturer’s fees from Medtronic, Stryker, Johnson & Johnson, Terumo, Medico’s Hirata, and Daiichi Sankyo. Dr. Takeuchi reports the lecturer’s fees from Stryker, Daiichi Sankyo, and Johnson & Johnson. Dr. Ikeda reports the lecturer’s fees from Medtronic, Daiichi Sankyo, and Terumo. Dr Tanaka reports lecturer’s fees from Stryker Dr. Ishihara reports lecture’s fees from Daiichi Sakyo and Stryker. Dr. Sano reports lecture’s fees from Stryker. Dr. Araki reports lecturer’s fees from Pfizer, Bristol-Myers Squibb, Daiichi Sankyo, Johnson & Johnson, Medico’s Hirata, Asahi-Intec, and Medtronic.Dr. Nomura reports lecture’s fee from Oben, Daiici Sankyo, Bayer, Wakamoto Seiyaku, Idorsia Pharma, Stryker, Medtronic, Kaneka, and Johnson&Johnson.Dr. Sakakibara reports manuscript fees from Medicus Shuppan. Dr. Yoshimura reports research grants from Medico’s Hirata, Medtronic, and Terumo; and lecturer fees from Medtronic, Kaneka, Stryker, Daiichi Sankyo, Bristol-Meyers Squibb, and Johnson & Johnson. Dr. Hayakawa, Dr.Ota, Dr.Morimoto and Dr.Kakita have no conflict of interest to declare.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.