Outcomes of Endovascular Mechanical Thrombectomy and Intravenous Tissue Plasminogen Activator for the Treatment of Vertebrobasilar Stroke

다국어 초록 (Multilingual Abstract)

Background and Purpose Aggressive treatment of posterior-circulation occlusions is important due to the high rates of morbidity and mortality associated with these infarctions. Alarge administrative database was evaluated to determine the outcomes of mechanical thrombectomy and intravenous tissue plasminogen activator (IV-tPA) for the treatment of posteriorcirculation (vertebrobasilar) strokes. Outcomes were compared across age groups.
Methods The United States Nationwide Inpatient Sample was used to evaluate the outcomesof patients treated for posterior-circulation acute ischemic stroke between 2006 and 2010. Patients who underwent endovascular mechanical thrombectomy and IV-tPA were selected. Primary outcomes were discharge status and mortality; secondary outcomes were length of stay,rate of intracranial hemorrhage, tracheostomy, and percutaneous endoscopic gastrostomy/jejunostomy tube placement. Outcomes were grouped according to age (i.e., <50, 50–64, and ≥65years). Chi-squared test and Student’s t-test were used for comparisons of categorical and continuous variables, respectively.
Results During 2006–2010 there were 36,675 patients who had discharge International Classification of Diseases (9th edition) codes indicating posterior-circulation strokes. Of these, 631(1.7%) underwent mechanical thrombectomy and 1554 (4.2%) underwent IV-tPA. The in-hospital mortality rate for mechanical thrombectomy patients was significantly lower for thoseaged <50 years than for those aged 50–64 years (30.4% versus 47.4%, p<0.01) and those aged≥65 years (30.4% versus 43.0%, p≤0.01). Age had no effect on the in-hospital mortality for IVtPA patients, with an incidence of 22.7% for patients aged <50 years, compared to 25.4% forpatients aged 50–64 years (p=0.46) and 23.0% for patients aged ≥65 years (p=0.92).
Conclusions Patients requiring IV-tPA and/or mechanical thrombectomy for the treatment ofposterior-circulation strokes suffer from high mortality rates. Increased age is associated withsignificantly higher mortality rates among posterior-circulation stroke patients who require mechanical thrombectomy.

참고문헌 (Reference)

1 Lutsep HL, "Vertebrobasilar revascularization rates and outcomes in the MERCI and multi-MERCI trials" 17 : 55-57, 2008

2 Nasr DM, "Utilization of intravenous thrombolysis is increasing in the United States" 8 : 681-688, 2013

3 Espinosa de Rueda M, "Treatment of acute vertebrobasilar occlusion using thrombectomy with stent retrievers: initial experience with 18patients" 34 : 1044-1048, 2013

4 Schonewille WJ, "Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS):a prospective registry study" 8 : 724-730, 2009

5 Vergouwen MD, "Time is brain(stem) in basilar artery occlusion" 43 : 3003-3006, 2012

6 Lindsberg PJ, "Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis" 37 : 922-928, 2006

7 Bose A, "The Penumbra System: a mechanical device for the treatment of acute stroke due to thromboembolism" 29 : 1409-1413., 2008

8 Mordasini P, "Technical feasibility and application of mechanical thrombectomy with the Solitaire FR Revascularization Device in acute basilar artery occlusion" 34 : 159-163, 2013

9 Smith WS, "Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial" 36 : 1432-1438, 2005

10 Costalat V, "Rescue, combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the solitaire device:a prospective 50-patient single-center study: timing, safety, and efficacy" 42 : 1929-1935, 2011

11 Brinjikji W, "Patient outcomes with endovascular embolectomy therapy for acute ischemic stroke: a study of the national inpatient sample: 2006 to 2008" 42 : 1648-1652, 2011

12 Schulte-Altedorneburg G, "Outcome of acute vertebrobasilar occlusions treated with intra-arterial fibrinolysis in 180 patients" 27 : 2042-2047, 2006

13 Hassan AE, "National trends in utilization and outcomes of endovascular treatment of acute ischemic stroke patients in the mechanical thrombectomy era" 43 : 3012-3017, 2012

14 Miteff F, "Mechanical thrombectomy with a self-expanding retrievable intracranial stent (Solitaire AB): experience in 26 patients with acute cerebral artery occlusion" 32 : 1078-1081, 2011

15 Smith WS, "Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial" 39 : 1205-1212, 2008

16 Andersson T, "Mechanical thrombectomy as the primary treatment for acute basilar artery occlusion: experience from 5 years of practice" 5 : 221-225, 2013

17 Hacke W, "Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS)" 274 : 1017-1025, 1995

18 Sairanen T, "Intravenous thrombolysis of basilar artery occlusion: predictors of recanalization and outcome" 42 : 2175-2179, 2011

19 Ciccone A, "Endovascular treatment for acute ischemic stroke" 368 : 904-913, 2013

20 Pfefferkorn T, "Drip, ship, and retrieve: cooperative recanalization therapy in acute basilar artery occlusion" 41 : 722-726, 2010

21 Davis SM, "Basilar artery thrombosis: recanalization is the key" 37 : 2440-, 2006

22 Mattle HP, "Basilar artery occlusion" 10 : 1002-1014, 2011

23 Hacke W, "Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials" 363 : 768-774, 2004

24 Arnold M, "Acute basilar artery occlusion in the Basilar Artery International Cooperation Study: does gender matter?" 41 : 2693-2696, 2010

25 Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies: development and validation" 40 : 373-383, 1987