Endovascular thrombectomy versus medical management for moderate-to-severe anterior cerebral artery occlusion stroke

Chen, Huanwen; Khunte, Mihir; Malhotra, Ajay; Gandhi, Dheeraj; Colasurdo, Marco

doi:10.1007/s00415-024-12582-z

J Neurol

2024

DOI: 10.1007/s00415-024-12582-z

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Endovascular thrombectomy versus medical management for moderate-to-severe anterior cerebral artery occlusion stroke

Huanwen Chen,

Mihir Khunte,

Ajay Malhotra

et al.

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2024

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Cited by 2 publications

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Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis

Chen,

Colasurdo,

Khunte

et al. 2024

J NeuroIntervent Surg

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BackgroundThe safety and efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes associated with infective endocarditis (IE) compared with medical management (MM) is unclear.MethodsIn this nationwide analysis of hospitalizations in the United States, we assessed the outcomes of EVT versus medical management (MM) for patients with LVO and IE. Primary outcome was routine home discharge with self-care. Secondary outcomes include home discharge, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Propensity score matching (PSM) was performed to adjust for confounders. Additional multivariable adjustments were performed for doubly robust analyses.Results2574 patients were identified; 656 (25.5%) received EVT. After PSM, the rate of routine discharge was significantly higher for patients with EVT compared with MM (14.6% vs 8.5%, p=0.021), and patients with EVT had significantly higher rate of home discharge (34.5% vs 26.5%, p=0.041), lower rate of in-hospital death (14.8% vs 25.2%, p=0.002), and lower rate of ICH (15.8% vs 23.1%, p=0.039). EVT was not associated with a different rate of SAH compared with MM (11.2% vs 7.9%, p=0.17). These associations remained unchanged with additional multivariable adjustments.ConclusionFor patients with LVO stroke and IE, EVT was associated with significantly higher odds of favorable hospitalization outcomes and lower odds of ICH compared with MM.

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Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis

Chen,

Colasurdo,

Khunte

et al. 2024

J NeuroIntervent Surg

View full text Add to dashboard Cite

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Post-Thrombectomy Subarachnoid Hemorrhage: Incidence, Predictors, Clinical Relevance, and Effect Modulators

Chen,

Colasurdo,

Khunte

et al. 2024

Diagnostics

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Background: Subarachnoid hemorrhage (SAH) following endovascular thrombectomy (EVT) is a poorly understood phenomenon, and whether it is associated with clinical detriment is unclear. Methods: This was an explorative analysis of a national database of real-world hospitalizations in the United States. Patients who underwent EVT were included. Patients were divided into SAH and non-SAH groups, and hospitalization outcomes were compared using multivariable logistic regression models. Regression models were also used to identify significant predictors for post-EVT SAH, and significant modulators of SAH’s association with hospitalization outcomes were also assessed. Results: A total of 99,219 EVT patients were identified; 6174 (6.2%) had SAH. Overall, SAH was independently associated with increased odds of in-hospital mortality (21.5% vs. 10.6%, adjusted OR 2.53 [95%CI 2.23–2.87], p < 0.001) and lower odds of routine discharge to home with self-care (18.2% vs. 28.0%, aOR 0.58 [95%CI 0.52–0.65], p < 0.001). Distal/medium vessel occlusion (DMVO), coagulopathy, angioplasty or stenting, concurrent intraparenchymal hemorrhage (IPH), and female sex were associated with higher odds of SAH. DMVO was associated with particularly heightened risk of death (31.8% vs. 7.9%, aOR 6.99 [95%CI 2.99 to 16.3], p < 0.001), which was an effect size significantly larger than other sites of vascular occlusion (interaction p > 0.05). Conclusion: SAH is an uncommon but likely clinically detrimental post-EVT complication. DMVO, coagulopathy, angioplasty or stenting, concurrent IPH, and female sex were independently associated with higher odds of post-EVT SAH. SAH associated with DMVO-EVT may be particularly harmful.

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Endovascular thrombectomy versus medical management for moderate-to-severe anterior cerebral artery occlusion stroke

Cited by 2 publications

References 24 publications

Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis

Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis

Post-Thrombectomy Subarachnoid Hemorrhage: Incidence, Predictors, Clinical Relevance, and Effect Modulators

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