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.
Data availability statement
Data are available upon reasonable request.
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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.
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