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Background <p>The impact of stroke etiology on outcomes in patients who underwent endovascular thrombectomy (EVT) is still a matter of debate. We studied the effect of aterosclerotic versus cardioembolic etiology on the clinical and radiological outcome of patients with stroke due to large vessel occlusion (LVO) treated with EVT on a large sample of stroke patients enrolled in a nationwide registry.</p> Methods <p>The source of data was the Italian Registry of Endovascular Stroke Treatments, a national, prospective, observational internet-based registry including patients treated with EVT since 2011. We extracted and compared data of patients suffering from large atherosclerosis (LAA) or cardioembolic (CE) stroke.</p> Results <p>We included 5193 patients, 3899 CE, and 1294 LAA stroke. Patients with CE were significantly older (<i>p</i> &lt; 0.001), and their stroke severity at admission was significantly higher (<i>p</i> &lt; 0.001). Moreover, patients with LAA had significantly longer onset to end of procedure time, and procedure duration than CE patients.</p> <p>Good outcome at three months was reported in 45.2% of LAA and 45.4% of CE patients (<i>p</i> = 0.89). In the multivariable analysis, patients with CE had higher odds of achieving successful (OR = 1.61; 95% CI 1.35–1.92) or complete (OR = 1.40; 95% CI 1.21–1.62) recanalization Futile recanalization was detected more frequently in CE patients (OR = 1.35; 95% CI 1.18–1.61). There were no statistically significant differences in clinical outcomes (mRS 02: OR = 1.12; 95% CI 0.92–1.36). LAA patients had higher odds of sICH (OR = 0.65; 95% CI 0.49–0.85). The shift analysis showed a trend toward a better outcome in CE patients (OR = 1.19; 95% CI 0.99–1.35), which was statistically significant in subjects with anterior circulation stroke. (OR = 1.21; 95% CI 1.04–1.35).</p> Conclusions <p>The study showed a better chance of successful recanalization in CE patients, a slightly better outcome in CE patients with anterior circulation stroke after adjusting for baseline confounders, despite their more unfavourable risk factor profile, and a higher chance of futile recanalization.</p>

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Procedural and Clinical Outcome of Stroke after thrombectomy according to etiology: results from a nationwide registry

  • 期刊论文

  • 发表日期：

    2025年4月2日

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  • Ilaria Casetta,
  • Giovanni Pracucci,
  • Valentina Saia,
  • Enrico Fainardi,
  • Fabrizio Sallustio,
  • Bruno Del Sette,
  • Tiziana Benzi Markushi,
  • Orazio Buonomo,
  • Ludovica Ferraù,
  • Mauro Bergui,
  • Paolo Cerrato,
  • Sandra Bracco,
  • Rossana Tassi,
  • Stefano Vallone,
  • Guido Bigliardi,
  • Guido A. Lazzarotti,
  • Nicola Giannini,
  • Leonardo Renieri,
  • Patrizia Nencini,
  • Daniele Romano,
  • Rosa Napoletano,
  • Simone Galluzzo,
  • Andrea Zini,
  • Roberto Menozzi,
  • Alessandro Pezzini,
  • Nicolò Mandruzzato,
  • Manuel Cappellari,
  • Maria Ruggiero,
  • Marco Longoni,
  • Sergio Nappini,
  • Federico Mazzacane,
  • Nicola Burdi,
  • Giovanni Boero,
  • Nicola Cavasin,
  • Adriana Critelli,
  • Andrea Calzoni,
  • Tiziana Tassinari,
  • Andrea Saletti,
  • Cristiano Azzini,
  • Valerio Da Ros,
  • Giordano Lacidogna,
  • Domenico S. Zimatore,
  • Marco Petruzzellis,
  • Davide Castellano,
  • Andrea Naldi,
  • Francesco Biraschi,
  • Ettore Nicolini,
  • Alessio Comai,
  • Elisa Dall’ Ora,
  • Emilio Lozupone,
  • Marcella Caggiula,
  • Ivan Gallesio,
  • Delfina Ferrandi,
  • Marco Perri,
  • Simona Sacco,
  • Michele Besana,
  • Alessia Giossi,
  • Giuseppe Carità,
  • Monia Russo,
  • Gianluca Galvano,
  • Eleonora Saracco,
  • Marco Pavia,
  • Paolo Invernizzi,
  • Marco Filizzolo,
  • Marina Mannino,
  • Edoardo Puglielli,
  • Alfonsina Casalena,
  • Salvatore Mangiafico,
  • Danilo Toni

摘要

Background

The impact of stroke etiology on outcomes in patients who underwent endovascular thrombectomy (EVT) is still a matter of debate. We studied the effect of aterosclerotic versus cardioembolic etiology on the clinical and radiological outcome of patients with stroke due to large vessel occlusion (LVO) treated with EVT on a large sample of stroke patients enrolled in a nationwide registry.

Methods

The source of data was the Italian Registry of Endovascular Stroke Treatments, a national, prospective, observational internet-based registry including patients treated with EVT since 2011. We extracted and compared data of patients suffering from large atherosclerosis (LAA) or cardioembolic (CE) stroke.

Results

We included 5193 patients, 3899 CE, and 1294 LAA stroke. Patients with CE were significantly older (p < 0.001), and their stroke severity at admission was significantly higher (p < 0.001). Moreover, patients with LAA had significantly longer onset to end of procedure time, and procedure duration than CE patients.

Good outcome at three months was reported in 45.2% of LAA and 45.4% of CE patients (p = 0.89). In the multivariable analysis, patients with CE had higher odds of achieving successful (OR = 1.61; 95% CI 1.35–1.92) or complete (OR = 1.40; 95% CI 1.21–1.62) recanalization Futile recanalization was detected more frequently in CE patients (OR = 1.35; 95% CI 1.18–1.61). There were no statistically significant differences in clinical outcomes (mRS 02: OR = 1.12; 95% CI 0.92–1.36). LAA patients had higher odds of sICH (OR = 0.65; 95% CI 0.49–0.85). The shift analysis showed a trend toward a better outcome in CE patients (OR = 1.19; 95% CI 0.99–1.35), which was statistically significant in subjects with anterior circulation stroke. (OR = 1.21; 95% CI 1.04–1.35).

Conclusions

The study showed a better chance of successful recanalization in CE patients, a slightly better outcome in CE patients with anterior circulation stroke after adjusting for baseline confounders, despite their more unfavourable risk factor profile, and a higher chance of futile recanalization.