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

M. Cappellari; G. Pracucci; S. Forlivesi; V. Saia; N. Limbucci; P. Nencini; D. Inzitari; V. Da Ros; F. Sallustio; S. Vallone; G. Bigliardi; A. Zini; S.L. Vinci; C. Dell’Aera; S. Bracco; S. Cioni; R. Tassi; M. Bergui; A. Naldi; G. Carità; C. Azzini; I. Casetta; R. Gasparotti; M. Magoni; L. Castellan; C. Finocchi; R. Menozzi; U. Scoditti; F. Causin; F. Viaro; E. Puglielli; A. Casalena; M. Ruggiero; S. Biguzzi; D. Castellano; R. Cavallo; G.A. Lazzarotti; G. Orlandi; A. Sgreccia; M.F. Denaro; N. Cavasin; A. Critelli; E.F.M. Ciceri; B. Bonetti; L. Chiumarulo; M. Petruzzelli; C. Pellegrino; F. Carimati; N. Burdi; M.P. Prontera; W. Auteri; A. Petrone; G. Guidetti; E. Nicolini; G. Ganci; A. Sugo; P. Filauri; S. Sacco; G. Squassina; P. Invernizzi; N.P. Nuzzi; M. Corato; P. Amistà; M. Gentile; S. Barbero; F. Schirru; G. Craparo; M. Mannino; L. Simonetti; S. Mangiafico; D. Toni

doi:10.1007/s00415-020-10098-w

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

M. Cappellari, G. Pracucci, S. Forlivesi, V. Saia, N. Limbucci, P. Nencini, D. Inzitari, V. Da Ros, F. Sallustio, S. Vallone, G. Bigliardi, A. Zini, S.L. Vinci, C. Dell’Aera, S. Bracco, S. Cioni, R. Tassi, M. Bergui, A. Naldi, G. CaritàC. Azzini, I. Casetta, R. Gasparotti, M. Magoni, L. Castellan, C. Finocchi, R. Menozzi, U. Scoditti, F. Causin, F. Viaro, E. Puglielli, A. Casalena, M. Ruggiero, S. Biguzzi, D. Castellano, R. Cavallo, G.A. Lazzarotti, G. Orlandi, A. Sgreccia, M.F. Denaro, N. Cavasin, A. Critelli, E.F.M. Ciceri, B. Bonetti, L. Chiumarulo, M. Petruzzelli, C. Pellegrino, F. Carimati, N. Burdi, M.P. Prontera, W. Auteri, A. Petrone, G. Guidetti, E. Nicolini, G. Ganci, A. Sugo, P. Filauri, S. Sacco, G. Squassina, P. Invernizzi, N.P. Nuzzi, M. Corato, P. Amistà, M. Gentile, S. Barbero, F. Schirru, G. Craparo, M. Mannino, L. Simonetti, S. Mangiafico, D. Toni

Research output: Contribution to journal › Article › peer-review

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. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.

Original language	English
Journal	J. Neurol.
DOIs	https://doi.org/10.1007/s00415-020-10098-w
Publication status	Published - 2020

Keywords

ARTICOLO
NEUROSCIENZE
RIS

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10.1007/s00415-020-10098-w

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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., ... Toni, D. (2020). Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis. J. Neurol.. https://doi.org/10.1007/s00415-020-10098-w

Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis. / 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.; Carità, G.; Azzini, C.; Casetta, I.; Gasparotti, R.; Magoni, M.; Castellan, L.; Finocchi, C.; Menozzi, R.; Scoditti, U.; Causin, F.; Viaro, F.; Puglielli, E.; Casalena, A.; Ruggiero, M.; Biguzzi, S.; Castellano, D.; Cavallo, R.; Lazzarotti, G.A.; Orlandi, G.; Sgreccia, A.; Denaro, M.F.; Cavasin, N.; Critelli, A.; Ciceri, E.F.M.; Bonetti, B.; Chiumarulo, L.; Petruzzelli, M.; Pellegrino, C.; Carimati, F.; Burdi, N.; Prontera, M.P.; Auteri, W.; Petrone, A.; Guidetti, G.; Nicolini, E.; Ganci, G.; Sugo, A.; Filauri, P.; Sacco, S.; Squassina, G.; Invernizzi, P.; Nuzzi, N.P.; Corato, M.; Amistà, P.; Gentile, M.; Barbero, S.; Schirru, F.; Craparo, G.; Mannino, M.; Simonetti, L.; Mangiafico, S.; Toni, D.

In: J. Neurol., 2020.

Research output: Contribution to journal › Article › peer-review

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, SL, Dell’Aera, C, Bracco, S, Cioni, S, Tassi, R, Bergui, M, Naldi, A, Carità, G, Azzini, C, Casetta, I, Gasparotti, R, Magoni, M, Castellan, L , Finocchi, C, Menozzi, R, Scoditti, U, Causin, F, Viaro, F, Puglielli, E, Casalena, A, Ruggiero, M, Biguzzi, S, Castellano, D, Cavallo, R, Lazzarotti, GA, Orlandi, G , Sgreccia, A , Denaro, MF, Cavasin, N, Critelli, A, Ciceri, EFM, Bonetti, B, Chiumarulo, L, Petruzzelli, M, Pellegrino, C, Carimati, F, Burdi, N, Prontera, MP, Auteri, W, Petrone, A, Guidetti, G, Nicolini, E, Ganci, G, Sugo, A, Filauri, P, Sacco, S, Squassina, G, Invernizzi, P, Nuzzi, NP , Corato, M, Amistà, P, Gentile, M, Barbero, S, Schirru, F, Craparo, G, Mannino, M, Simonetti, L, Mangiafico, S & Toni, D 2020, 'Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis', J. Neurol.. https://doi.org/10.1007/s00415-020-10098-w

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. ; Carità, G. ; Azzini, C. ; Casetta, I. ; Gasparotti, R. ; Magoni, M. ; Castellan, L. ; Finocchi, C. ; Menozzi, R. ; Scoditti, U. ; Causin, F. ; Viaro, F. ; Puglielli, E. ; Casalena, A. ; Ruggiero, M. ; Biguzzi, S. ; Castellano, D. ; Cavallo, R. ; Lazzarotti, G.A. ; Orlandi, G. ; Sgreccia, A. ; Denaro, M.F. ; Cavasin, N. ; Critelli, A. ; Ciceri, E.F.M. ; Bonetti, B. ; Chiumarulo, L. ; Petruzzelli, M. ; Pellegrino, C. ; Carimati, F. ; Burdi, N. ; Prontera, M.P. ; Auteri, W. ; Petrone, A. ; Guidetti, G. ; Nicolini, E. ; Ganci, G. ; Sugo, A. ; Filauri, P. ; Sacco, S. ; Squassina, G. ; Invernizzi, P. ; Nuzzi, N.P. ; Corato, M. ; Amistà, P. ; Gentile, M. ; Barbero, S. ; Schirru, F. ; Craparo, G. ; Mannino, M. ; Simonetti, L. ; Mangiafico, S. ; Toni, D. / Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis. In: J. Neurol. 2020.

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title = "Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis",

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. {\textcopyright} 2020, Springer-Verlag GmbH Germany, part of Springer Nature.",

keywords = "ARTICOLO, NEUROSCIENZE, RIS",

author = "M. Cappellari and G. Pracucci and S. Forlivesi and V. Saia and N. Limbucci and P. Nencini and D. Inzitari and {Da Ros}, V. and F. Sallustio and S. Vallone and G. Bigliardi and A. Zini and S.L. Vinci and C. Dell{\textquoteright}Aera and S. Bracco and S. Cioni and R. Tassi and M. Bergui and A. Naldi and G. Carit{\`a} and C. Azzini and I. Casetta and R. Gasparotti and M. Magoni and L. Castellan and C. Finocchi and R. Menozzi and U. Scoditti and F. Causin and F. Viaro and E. Puglielli and A. Casalena and M. Ruggiero and S. Biguzzi and D. Castellano and R. Cavallo and G.A. Lazzarotti and G. Orlandi and A. Sgreccia and M.F. Denaro and N. Cavasin and A. Critelli and E.F.M. Ciceri and B. Bonetti and L. Chiumarulo and M. Petruzzelli and C. Pellegrino and F. Carimati and N. Burdi and M.P. Prontera and W. Auteri and A. Petrone and G. Guidetti and E. Nicolini and G. Ganci and A. Sugo and P. Filauri and S. Sacco and G. Squassina and P. Invernizzi and N.P. Nuzzi and M. Corato and P. Amist{\`a} and M. Gentile and S. Barbero and F. Schirru and G. Craparo and M. Mannino and L. Simonetti and S. Mangiafico and D. Toni",

year = "2020",

doi = "10.1007/s00415-020-10098-w",

language = "English",

journal = "J. Neurol.",

issn = "0340-5354",

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TY - JOUR

T1 - Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis

AU - Cappellari, M.

AU - Pracucci, G.

AU - Forlivesi, S.

AU - Saia, V.

AU - Limbucci, N.

AU - Nencini, P.

AU - Inzitari, D.

AU - Da Ros, V.

AU - Sallustio, F.

AU - Vallone, S.

AU - Bigliardi, G.

AU - Zini, A.

AU - Vinci, S.L.

AU - Dell’Aera, C.

AU - Bracco, S.

AU - Cioni, S.

AU - Tassi, R.

AU - Bergui, M.

AU - Naldi, A.

AU - Carità, G.

AU - Azzini, C.

AU - Casetta, I.

AU - Gasparotti, R.

AU - Magoni, M.

AU - Castellan, L.

AU - Finocchi, C.

AU - Menozzi, R.

AU - Scoditti, U.

AU - Causin, F.

AU - Viaro, F.

AU - Puglielli, E.

AU - Casalena, A.

AU - Ruggiero, M.

AU - Biguzzi, S.

AU - Castellano, D.

AU - Cavallo, R.

AU - Lazzarotti, G.A.

AU - Orlandi, G.

AU - Sgreccia, A.

AU - Denaro, M.F.

AU - Cavasin, N.

AU - Critelli, A.

AU - Ciceri, E.F.M.

AU - Bonetti, B.

AU - Chiumarulo, L.

AU - Petruzzelli, M.

AU - Pellegrino, C.

AU - Carimati, F.

AU - Burdi, N.

AU - Prontera, M.P.

AU - Auteri, W.

AU - Petrone, A.

AU - Guidetti, G.

AU - Nicolini, E.

AU - Ganci, G.

AU - Sugo, A.

AU - Filauri, P.

AU - Sacco, S.

AU - Squassina, G.

AU - Invernizzi, P.

AU - Nuzzi, N.P.

AU - Corato, M.

AU - Amistà, P.

AU - Gentile, M.

AU - Barbero, S.

AU - Schirru, F.

AU - Craparo, G.

AU - Mannino, M.

AU - Simonetti, L.

AU - Mangiafico, S.

AU - Toni, D.

PY - 2020

Y1 - 2020

N2 - 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. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.

AB - 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. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.

KW - ARTICOLO

KW - NEUROSCIENZE

KW - RIS

U2 - 10.1007/s00415-020-10098-w

DO - 10.1007/s00415-020-10098-w

M3 - Article

JO - J. Neurol.

JF - J. Neurol.

SN - 0340-5354

ER -