Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis

Manuel Cappellari, Giovanni Pracucci, Stefano Forlivesi, Valentina Saia, Nicola Limbucci, Patrizia Nencini, Domenico Inzitari, Valerio Da Ros, Fabrizio Sallustio, Stefano Vallone, Guido Bigliardi, Andrea Zini, Sergio Lucio Vinci, Cristina Dell’Aera, Sandra Bracco, Samuele Cioni, Rossana Tassi, Mauro Bergui, Andrea Naldi, Giuseppe CaritàCristiano Azzini, Ilaria Casetta, Roberto Gasparotti, Mauro Magoni, Lucio Castellan, Cinzia Finocchi, Roberto Menozzi, Umberto Scoditti, Francesco Causin, Federica Viaro, Edoardo Puglielli, Alfonsina Casalena, Maria Ruggiero, Sara Biguzzi, Davide Castellano, Roberto Cavallo, Guido Andrea Lazzarotti, Giovanni Orlandi, Alessandro Sgreccia, Maria Federica Denaro, Nicola Cavasin, Adriana Critelli, Elisa Francesca Maria Ciceri, Bruno Bonetti, Luigi Chiumarulo, Marco Petruzzelli, Carlo Pellegrino, Simona Sacco, Nunzio Paolo Nuzzi, Manuel Corato

Research output: Contribution to journalArticle

Abstract

Background: Intravenous thrombolysis (IVT)-ineligible patients undergoing direct thrombectomy tended to have poorer functional outcome as compared with IVT-eligible patients undergoing bridging therapy. We aimed to assess radiological and functional outcomes in large vessel occlusion-related stroke patients receiving direct thrombectomy in the presence of absolute exclusion criteria for IVT vs relative exclusion criteria for IVT and vs non-exclusion criteria for IVT. Methods: A cohort study on prospectively collected data from 2282 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke cohort for treatment with direct thrombectomy (n = 486, absolute exclusion criteria for IVT alone; n = 384, absolute in combination with relative exclusion criteria for IVT; n = 777, relative exclusion criteria for IVT alone; n = 635, non-exclusion criteria for IVT). Results: After adjustment for unbalanced variables (model 1), ORs for 3-month death was higher in the presence of absolute exclusion criteria for IVT alone (vs relative exclusion criteria for IVT alone) (1.595, 95% CI 1.042–2.440) and in the presence of absolute exclusion criteria for IVT alone (vs non-exclusion criteria for IVT) (1.235, 95% CI 1.014–1.504). After adjustment for predefined variables (model 2: age, sex, pre-stroke mRS ≤ 1, NIHSS, occlusion in the anterior circulation, onset-to-groin time, and procedure time), ORs for 3-month death was higher in the presence of absolute exclusion criteria for IVT alone (vs relative exclusion criteria for IVT alone) (1.235, 95% CI 1.014–1.504) and in the presence of absolute exclusion criteria for IVT alone (vs non-exclusion criteria for IVT) (1.246, 95% CI 1.039–1.495). No significant difference was found between the groups as regards any type of intracerebral hemorrhage and parenchymal hematoma within 24 h, successful and complete recanalization after procedure, and modified Rankin Scale score 0–2 at 3 months. After adjustment for predefined variables of model 2, ORs for death were higher in the presence of recent administration of IV heparin (OR: 2.077), platelet count < 100,000/mm3 (OR: 4.798), bacterial endocarditis (OR: 15.069), neoplasm with increased hemorrhagic risk (OR: 6.046), and severe liver disease (OR: 6.124). Conclusions: Radiological outcomes were similar after direct thrombectomy in patients with absolute, relative, and non- exclusion criteria for IVT, while an increase of fatal outcome was observed in the presence of some absolute exclusion criterion for IVT.

Original languageEnglish
JournalJournal of Neurology
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Outcome
  • Stroke
  • Thrombectomy
  • Thrombolysis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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    Cappellari, M., Pracucci, G., Forlivesi, S., Saia, V., Limbucci, N., Nencini, P., Inzitari, D., Da Ros, V., Sallustio, F., Vallone, S., Bigliardi, G., Zini, A., Vinci, S. L., Dell’Aera, C., Bracco, S., Cioni, S., Tassi, R., Bergui, M., Naldi, A., ... Corato, M. (Accepted/In press). Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis. Journal of Neurology. https://doi.org/10.1007/s00415-020-10098-w