Endovascular Treatment for Acute Isolated Internal Carotid Artery Occlusion: A Propensity Score Matched Multicenter Study
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| Název: | Endovascular Treatment for Acute Isolated Internal Carotid Artery Occlusion: A Propensity Score Matched Multicenter Study |
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| Autoři: | Daniel P. O. Kaiser, Tilman Reiff, Ulrich Mansmann, Daniela Schoene, Davide Strambo, Patrik Michel, Mohamad Abdalkader, Thanh N. Nguyen, Matthias Gawlitza, Markus A. Möhlenbruch, Peter A. Ringleb, Volker Puetz, Johannes C. Gerber, Simon Nagel |
| Zdroj: | Clin Neuroradiol Clinical neuroradiology, vol. 34, no. 1, pp. 125-133 |
| Informace o vydavateli: | Springer Science and Business Media LLC, 2023. |
| Rok vydání: | 2023 |
| Témata: | Carotid Artery Diseases, Endovascular Procedures, Arterial Occlusive Diseases, 3. Good health, Brain Ischemia, Stroke, Treatment Outcome, Risk Factors, Humans, Original Article, Propensity Score, Intracranial Hemorrhages, Stroke/therapy [MeSH], Endovascular Procedures/methods [MeSH], Thrombectomy/methods [MeSH], Humans [MeSH], Treatment Outcome [MeSH], Angiography, Risk Factors [MeSH], Carotid Artery Diseases/complications [MeSH], Arterial Occlusive Diseases/complications [MeSH], Intracranial Hemorrhages/etiology [MeSH], Intervention, Cervical, Thrombectomy, Carotid Artery, Internal/diagnostic imaging [MeSH], Propensity Score [MeSH], Brain Ischemia/therapy [MeSH], Carotid Artery, Internal/diagnostic imaging, Stroke/therapy, Intracranial Hemorrhages/etiology, Arterial Occlusive Diseases/complications, Carotid Artery Diseases/complications, Endovascular Procedures/methods, Thrombectomy/methods, Brain Ischemia/therapy, Carotid Artery, Internal |
| Popis: | Purpose The benefit of endovascular treatment (EVT) in patients with acute symptomatic isolated occlusion of the internal carotid artery (ICA) without involvement of the middle and anterior cerebral arteries is unclear. We aimed to compare clinical and safety outcomes of best medical treatment (BMT) versus EVT + BMT in patients with stroke due to isolated ICA occlusion. Methods We conducted a retrospective multicenter study involving patients with isolated ICA occlusion between January 2016 and December 2020. We stratified patients by BMT versus EVT and matched the groups using propensity score matching (PSM). We assessed the effect of treatment strategy on favorable outcome (modified Rankin scale ≤ 2) 90 days after treatment and compared reduction in NIHSS score at discharge, rates of symptomatic intracranial hemorrhage (sICH) and 3‑month mortality. Results In total, we included 149 patients with isolated ICA occlusion. To address imbalances, we matched 45 patients from each group using PSM. The rate of favorable outcomes at 90 days was 56% for EVT and 38% for BMT (odds ratio, OR 1.89, 95% confidence interval, CI 0.84–4.24; p = 0.12). Patients treated with EVT showed a median reduction in NIHSS score at discharge of 6 points compared to 1 point for BMT patients (p = 0.02). Rates of symptomatic intracranial hemorrhage (7% vs. 4%; p = 0.66) and 3‑month mortality (11% vs. 13%; p = 0.74) did not differ between treatment groups. Periprocedural complications of EVT with early neurological deterioration occurred in 7% of cases. Conclusion Although the benefit on functional outcome did not reach statistical significance, the results for NIHSS score improvement, and safety support the use of EVT in patients with stroke due to isolated ICA occlusion. |
| Druh dokumentu: | Article Other literature type |
| Popis souboru: | application/pdf |
| Jazyk: | English |
| ISSN: | 1869-1447 1869-1439 |
| DOI: | 10.1007/s00062-023-01342-7 |
| Přístupová URL adresa: | https://pubmed.ncbi.nlm.nih.gov/37665352 https://serval.unil.ch/notice/serval:BIB_F68C3F62D056 http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_F68C3F62D0564 https://serval.unil.ch/resource/serval:BIB_F68C3F62D056.P001/REF.pdf https://repository.publisso.de/resource/frl:6519203 |
| Rights: | CC BY |
| Přístupové číslo: | edsair.doi.dedup.....7c8ae930713d9acc3c1ee10f6ea4a996 |
| Databáze: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstrakt: | Purpose The benefit of endovascular treatment (EVT) in patients with acute symptomatic isolated occlusion of the internal carotid artery (ICA) without involvement of the middle and anterior cerebral arteries is unclear. We aimed to compare clinical and safety outcomes of best medical treatment (BMT) versus EVT + BMT in patients with stroke due to isolated ICA occlusion. Methods We conducted a retrospective multicenter study involving patients with isolated ICA occlusion between January 2016 and December 2020. We stratified patients by BMT versus EVT and matched the groups using propensity score matching (PSM). We assessed the effect of treatment strategy on favorable outcome (modified Rankin scale ≤ 2) 90 days after treatment and compared reduction in NIHSS score at discharge, rates of symptomatic intracranial hemorrhage (sICH) and 3‑month mortality. Results In total, we included 149 patients with isolated ICA occlusion. To address imbalances, we matched 45 patients from each group using PSM. The rate of favorable outcomes at 90 days was 56% for EVT and 38% for BMT (odds ratio, OR 1.89, 95% confidence interval, CI 0.84–4.24; p = 0.12). Patients treated with EVT showed a median reduction in NIHSS score at discharge of 6 points compared to 1 point for BMT patients (p = 0.02). Rates of symptomatic intracranial hemorrhage (7% vs. 4%; p = 0.66) and 3‑month mortality (11% vs. 13%; p = 0.74) did not differ between treatment groups. Periprocedural complications of EVT with early neurological deterioration occurred in 7% of cases. Conclusion Although the benefit on functional outcome did not reach statistical significance, the results for NIHSS score improvement, and safety support the use of EVT in patients with stroke due to isolated ICA occlusion. |
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| ISSN: | 18691447 18691439 |
| DOI: | 10.1007/s00062-023-01342-7 |