Compared with medical therapy, thrombectomy was associated with better 90-day outcomes in these cases.
Endovascular thrombectomy results in favorable outcomes for patients with acute ischemic stroke caused by cervical artery dissection, according to a small retrospective analysis published recently online ahead of print in Stroke.
While rare overall, cervical artery dissection is a relatively common cause of stroke in young adults, write lead author Shun Li, MD (Jinling Hospital, Southern Medical University, Nanjing) and colleagues.
“Acute ischemic stroke associated with cervical artery dissection is traditionally treated with anticoagulants or antiplatelets,” they write. “However, stroke patients with large artery occlusion because of cervical artery dissection may have poorer prognosis even if treated with intravenous thrombolysis. More aggressive and more efficacious treatments may be needed in these patients.”
To help clarify the potential role of endovascular thrombectomy, the investigators identified 160 patients with large vessel occlusion (LVO) acute ischemic stroke and cervical artery dissection. Half of the patients underwent thrombectomy in addition to medical therapy and half did not. Using propensity-score matching, a total of 48 patients who underwent thrombectomy and 48 who did not were matched for further analysis.
Thrombectomy patients were more likely than those who did not have thrombectomy to be older, have higher National Institutes of Health Stroke Scale scores, and to have intravenous thrombolysis and tandem occlusions.
Functional Outcome at 90 Days Better With Thrombectomy
The proportion of patients with a favorable outcome, defined as 90-day mRS score 0-2, was higher in those who underwent thrombectomy than in those who did not. The two groups were similar, however, with respect to the incidence of symptomatic intracranial hemorrhage (ICH) and 90-day mortality.
Outcomes of LVO Stroke and Cervical Artery Dissection
|
|
Thrombectomy n = 48 |
No Thrombectomy n = 48 |
P Value |
|
90-Day mRS Score |
66.7% |
39.6% |
0.008 |
|
Symptomatic ICH |
8.3% |
4.2% |
0.677 |
|
90-Day Mortality |
10.4% |
6.3% |
0.714 |
The authors identify several limitations to their study, including its retrospective nature and differing protocols for treatment selection among the participating hospitals. They also point out that patients treated with thrombectomy were compared with historical controls treated years earlier. In that time, improvements in care may have biased the results toward superior outcomes in the thrombectomy group. The entire duration of the trial, however, was only 5.5 years.
“Endovascular thrombectomy seems to be an effective treatment in selected patients with acute ischemic stroke associated with cervical artery dissection,” Li et al conclude. “Considering the relatively high ratio of symptomatic ICH and mortality, the safety of thrombectomy warrants further study.”
Source:
Li S, Zi W, Chen J, et al. Feasibility of thrombectomy in treating acute ischemic stroke because of cervical artery dissection. Stroke. 2018;Epub ahead of print.
Disclosures:
Li reports no relevant conflicts of interest.
