Thrombectomy vs medical management in low NIHSS acute anterior
circulation stroke

J 2020

Thrombectomy vs medical management in low NIHSS acute anterior circulation stroke

VOLNÝ, Ondřej, Charlotte ZERNA, Ales TOMEK, Michal BAR, Miloslav ROCEK et. al.

Basic information

Original name

Thrombectomy vs medical management in low NIHSS acute anterior circulation stroke

Authors

VOLNÝ, Ondřej (203 Czech Republic, belonging to the institution), Charlotte ZERNA (124 Canada, guarantor), Ales TOMEK (203 Czech Republic), Michal BAR (203 Czech Republic), Miloslav ROCEK (203 Czech Republic), Radek PADR (203 Czech Republic), Filip CIHLAR (203 Czech Republic), Miroslava NEVSIMALOVA (203 Czech Republic), Lubomir JURAK (203 Czech Republic), Roman HAVLICEK (203 Czech Republic), Martin KOVAR (203 Czech Republic), Petr SEVCIK (203 Czech Republic), Vladimir ROHAN (203 Czech Republic), Jan FIKSA (203 Czech Republic), David CERNIK (203 Czech Republic), René JURA (203 Czech Republic, belonging to the institution), Daniel VACLAVIK (203 Czech Republic), Petra CIMFLOVÁ (203 Czech Republic, belonging to the institution), Josep PUIG, Dar DOWLATSHAHI, Alexander V. KHAW, Enrico FAINARDI, Mohamed NAJM, Andrew M. DEMCHUK, Bijoy K. MENON, Robert MIKULÍK (203 Czech Republic, belonging to the institution) and Michael D. HILL

Edition

Neurology, Philadelphia, LIPPINCOTT WILLIAMS & WILKINS, 2020, 0028-3878

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30210 Clinical neurology

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 9.910

RIV identification code

RIV/00216224:14110/20:00118138

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1212/WNL.0000000000010955

UT WoS

000607315800032

Keywords in English

Thrombectomy; acute anterior circulation stroke

Abstract

V originále

Objective To undertake an effectiveness and safety analysis of EVT in patients with LVO and NIH Stroke Scale (NIHSS) score <= 6 using datasets of multicenter and multinational nature. Methods We pooled patients with anterior circulation occlusion from 3 prospective international cohorts. Patients were eligible if presentation occurred within 12 hours from last known well and baseline NIHSS <= 6. Primary outcome was modified Rankin Scale (mRS) score 0-1 at 90 days. Secondary outcomes included neurologic deterioration at 24 hours (change in NIHSS of >= 2 points), mRS 0-2 at 90 days, and 90-day all-cause mortality. We used propensity score matching to adjust for nonrandomized treatment allocation. Results Among 236 patients who fit inclusion criteria, 139 received EVT and 97 received medical management. Compared tomedical management, the EVT group was younger (65 vs 72 years; p < 0.001), had more proximal occlusions (p < 0.001), and less frequently received concurrent IV thrombolysis (57.7% vs 71.2%; p = 0.04). After propensity score matching, clinical outcomes between the 2 groups were not significantly different. EVT patients had an 8.6% (95% confidence interval [CI] -8.8% to 26.1%) higher rate of excellent 90-day outcome, despite a 22.3% (95% CI, 3.0%-41.6%) higher risk of neurologic deterioration at 24 hours. Conclusions EVT for LVO in patients with low NIHSS score was associated with increased risk of neurologic deterioration at 24 hours. However, both EVT and medical management resulted in similar proportions of excellent clinical outcomes at 90 days. Classification of evidence This study providesClass III evidence that for patients with acute anterior circulation ischemic strokes and LVO with NIHSS < 6, EVT and medical management result in similar outcomes at 90 days.

Citovat

VOLNÝ, Ondřej, Charlotte ZERNA, Ales TOMEK, Michal BAR, Miloslav ROCEK, Radek PADR, Filip CIHLAR, Miroslava NEVSIMALOVA, Lubomir JURAK, Roman HAVLICEK, Martin KOVAR, Petr SEVCIK, Vladimir ROHAN, Jan FIKSA, David CERNIK, René JURA, Daniel VACLAVIK, Petra CIMFLOVÁ, Josep PUIG, Dar DOWLATSHAHI, Alexander V. KHAW, Enrico FAINARDI, Mohamed NAJM, Andrew M. DEMCHUK, Bijoy K. MENON, Robert MIKULÍK and Michael D. HILL. Thrombectomy vs medical management in low NIHSS acute anterior circulation stroke. Neurology. Philadelphia: LIPPINCOTT WILLIAMS & WILKINS, 2020, vol. 95, No 24, p. "E3364"-"E3372", 9 pp. ISSN 0028-3878. Available from: https://dx.doi.org/10.1212/WNL.0000000000010955.

@article{1739896,
   author = {Volný, Ondřej and Zerna, Charlotte and Tomek, Ales and Bar, Michal and Rocek, Miloslav and Padr, Radek and Cihlar, Filip and Nevsimalova, Miroslava and Jurak, Lubomir and Havlicek, Roman and Kovar, Martin and Sevcik, Petr and Rohan, Vladimir and Fiksa, Jan and Cernik, David and Jura, René and Vaclavik, Daniel and Cimflová, Petra and Puig, Josep and Dowlatshahi, Dar and Khaw, Alexander V. and Fainardi, Enrico and Najm, Mohamed and Demchuk, Andrew M. and Menon, Bijoy K. and Mikulík, Robert and Hill, Michael D.},
   article_location = {Philadelphia},
   article_number = {24},
   doi = {http://dx.doi.org/10.1212/WNL.0000000000010955},
   keywords = {Thrombectomy; acute anterior circulation stroke},
   language = {eng},
   issn = {0028-3878},
   journal = {Neurology},
   title = {Thrombectomy vs medical management in low NIHSS acute anterior circulation stroke},
   url = {https://n.neurology.org/content/95/24/e3364},
   volume = {95},
   year = {2020}
}

TY  - JOUR
ID  - 1739896
AU  - Volný, Ondřej - Zerna, Charlotte - Tomek, Ales - Bar, Michal - Rocek, Miloslav - Padr, Radek - Cihlar, Filip - Nevsimalova, Miroslava - Jurak, Lubomir - Havlicek, Roman - Kovar, Martin - Sevcik, Petr - Rohan, Vladimir - Fiksa, Jan - Cernik, David - Jura, René - Vaclavik, Daniel - Cimflová, Petra - Puig, Josep - Dowlatshahi, Dar - Khaw, Alexander V. - Fainardi, Enrico - Najm, Mohamed - Demchuk, Andrew M. - Menon, Bijoy K. - Mikulík, Robert - Hill, Michael D.
PY  - 2020
TI  - Thrombectomy vs medical management in low NIHSS acute anterior circulation stroke
JF  - Neurology
VL  - 95
IS  - 24
SP  - "E3364"-"E3372"
EP  - "E3364"-"E3372"
PB  - LIPPINCOTT WILLIAMS & WILKINS
SN  - 00283878
KW  - Thrombectomy
KW  - acute anterior circulation stroke
UR  - https://n.neurology.org/content/95/24/e3364
L2  - https://n.neurology.org/content/95/24/e3364
N2  - Objective To undertake an effectiveness and safety analysis of EVT in patients with LVO and NIH Stroke Scale (NIHSS) score <= 6 using datasets of multicenter and multinational nature. Methods We pooled patients with anterior circulation occlusion from 3 prospective international cohorts. Patients were eligible if presentation occurred within 12 hours from last known well and baseline NIHSS <= 6. Primary outcome was modified Rankin Scale (mRS) score 0-1 at 90 days. Secondary outcomes included neurologic deterioration at 24 hours (change in NIHSS of >= 2 points), mRS 0-2 at 90 days, and 90-day all-cause mortality. We used propensity score matching to adjust for nonrandomized treatment allocation. Results Among 236 patients who fit inclusion criteria, 139 received EVT and 97 received medical management. Compared tomedical management, the EVT group was younger (65 vs 72 years; p < 0.001), had more proximal occlusions (p < 0.001), and less frequently received concurrent IV thrombolysis (57.7% vs 71.2%; p = 0.04). After propensity score matching, clinical outcomes between the 2 groups were not significantly different. EVT patients had an 8.6% (95% confidence interval [CI] -8.8% to 26.1%) higher rate of excellent 90-day outcome, despite a 22.3% (95% CI, 3.0%-41.6%) higher risk of neurologic deterioration at 24 hours. Conclusions EVT for LVO in patients with low NIHSS score was associated with increased risk of neurologic deterioration at 24 hours. However, both EVT and medical management resulted in similar proportions of excellent clinical outcomes at 90 days. Classification of evidence This study providesClass III evidence that for patients with acute anterior circulation ischemic strokes and LVO with NIHSS < 6, EVT and medical management result in similar outcomes at 90 days.
ER  -

VOLNÝ, Ondřej, Charlotte ZERNA, Ales TOMEK, Michal BAR, Miloslav ROCEK, Radek PADR, Filip CIHLAR, Miroslava NEVSIMALOVA, Lubomir JURAK, Roman HAVLICEK, Martin KOVAR, Petr SEVCIK, Vladimir ROHAN, Jan FIKSA, David CERNIK, René JURA, Daniel VACLAVIK, Petra CIMFLOVÁ, Josep PUIG, Dar DOWLATSHAHI, Alexander V. KHAW, Enrico FAINARDI, Mohamed NAJM, Andrew M. DEMCHUK, Bijoy K. MENON, Robert MIKULÍK and Michael D. HILL. Thrombectomy vs medical management in low NIHSS acute anterior circulation stroke. \textit{Neurology}. Philadelphia: LIPPINCOTT WILLIAMS \&{} WILKINS, 2020, vol.~95, No~24, p.~''E3364''-''E3372'', 9 pp. ISSN~0028-3878. Available from: https://dx.doi.org/10.1212/WNL.0000000000010955.

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