Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis
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 p...
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| Veröffentlicht in: | Journal of neurology 2020-12, Vol.267 (12), p.3731-3740 |
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| creator | Cappellari, Manuel Pracucci, Giovanni Forlivesi, Stefano Saia, Valentina Limbucci, Nicola Nencini, Patrizia Inzitari, Domenico Da Ros, Valerio Sallustio, Fabrizio Vallone, Stefano Bigliardi, Guido Zini, Andrea Vinci, Sergio Lucio Dell’Aera, Cristina Bracco, Sandra Cioni, Samuele Tassi, Rossana Bergui, Mauro Naldi, Andrea Carità, Giuseppe Azzini, Cristiano Casetta, Ilaria Gasparotti, Roberto Magoni, Mauro Castellan, Lucio Finocchi, Cinzia Menozzi, Roberto Scoditti, Umberto Causin, Francesco Viaro, Federica Puglielli, Edoardo Casalena, Alfonsina Ruggiero, Maria Biguzzi, Sara Castellano, Davide Cavallo, Roberto Lazzarotti, Guido Andrea Orlandi, Giovanni Sgreccia, Alessandro Denaro, Maria Federica Cavasin, Nicola Critelli, Adriana Ciceri, Elisa Francesca Maria Bonetti, Bruno Chiumarulo, Luigi Petruzzelli, Marco Pellegrino, Carlo Carimati, Federico Burdi, Nicola Prontera, Maria Pia Auteri, Wiliam Petrone, Alfredo Guidetti, Giulio Nicolini, Ettore Ganci, Giuseppe Sugo, Annalisa Filauri, Pietro Sacco, Simona Squassina, Guido Invernizzi, Paolo Nuzzi, Nunzio Paolo Corato, Manuel Amistà, Pietro Gentile, Mauro Barbero, Stefano Schirru, Federica Craparo, Giuseppe Mannino, Marina Simonetti, Luigi Mangiafico, Salvatore Toni, Danilo |
| description | 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 |
| doi_str_mv | 10.1007/s00415-020-10098-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2427525238</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2837212347</sourcerecordid><originalsourceid>FETCH-LOGICAL-c396t-69f2d2859d6d74b6283bf1c9917d2493b1cf9a8b3a4a3e9dca61115a32e38e103</originalsourceid><addsrcrecordid>eNp9kE1LxDAQhoMouK7-AU8BL16i-epHjrJ-woIXvRrSdKpZ22ZNWtb998atIHjwNDPM874zvAidMnrBKC0uI6WSZYRyStKsSrLZQzMmBSdMZmofzaiQlGQik4foKMYVpbRMixl6uXYB7ICHt-C7KnW-2-LGBxyH4N8Buz6tAK8DROgtYN9gU0XfjgNg-LTtGJ3vsQ1ugODMTjlZ-XYbXTxGB41pI5z81Dl6vr15WtyT5ePdw-JqSaxQ-UBy1fCal5mq87qQVc5LUTXMKsWKmkslKmYbZcpKGGkEqNqanDGWGcFBlMComKPzyXcd_McIcdCdixba1vTgx6i55EXGMy7KhJ79QVd-DH36TqezBWdcyCJRfKJs8DEGaPQ6uM6ErWZUf0eup8h1ilzvItebJBKTKCa4f4Xwa_2P6guj-oVN</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2837212347</pqid></control><display><type>article</type><title>Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis</title><source>SpringerLink Journals - AutoHoldings</source><creator>Cappellari, Manuel ; Pracucci, Giovanni ; Forlivesi, Stefano ; Saia, Valentina ; Limbucci, Nicola ; Nencini, Patrizia ; Inzitari, Domenico ; Da Ros, Valerio ; Sallustio, Fabrizio ; Vallone, Stefano ; Bigliardi, Guido ; Zini, Andrea ; Vinci, Sergio Lucio ; Dell’Aera, Cristina ; Bracco, Sandra ; Cioni, Samuele ; Tassi, Rossana ; Bergui, Mauro ; Naldi, Andrea ; Carità, Giuseppe ; Azzini, Cristiano ; Casetta, Ilaria ; Gasparotti, Roberto ; Magoni, Mauro ; Castellan, Lucio ; Finocchi, Cinzia ; Menozzi, Roberto ; Scoditti, Umberto ; Causin, Francesco ; Viaro, Federica ; Puglielli, Edoardo ; Casalena, Alfonsina ; Ruggiero, Maria ; Biguzzi, Sara ; Castellano, Davide ; Cavallo, Roberto ; Lazzarotti, Guido Andrea ; Orlandi, Giovanni ; Sgreccia, Alessandro ; Denaro, Maria Federica ; Cavasin, Nicola ; Critelli, Adriana ; Ciceri, Elisa Francesca Maria ; Bonetti, Bruno ; Chiumarulo, Luigi ; Petruzzelli, Marco ; Pellegrino, Carlo ; Carimati, Federico ; Burdi, Nicola ; Prontera, Maria Pia ; Auteri, Wiliam ; Petrone, Alfredo ; Guidetti, Giulio ; Nicolini, Ettore ; Ganci, Giuseppe ; Sugo, Annalisa ; Filauri, Pietro ; Sacco, Simona ; Squassina, Guido ; Invernizzi, Paolo ; Nuzzi, Nunzio Paolo ; Corato, Manuel ; Amistà, Pietro ; Gentile, Mauro ; Barbero, Stefano ; Schirru, Federica ; Craparo, Giuseppe ; Mannino, Marina ; Simonetti, Luigi ; Mangiafico, Salvatore ; Toni, Danilo</creator><creatorcontrib>Cappellari, Manuel ; Pracucci, Giovanni ; Forlivesi, Stefano ; Saia, Valentina ; Limbucci, Nicola ; Nencini, Patrizia ; Inzitari, Domenico ; Da Ros, Valerio ; Sallustio, Fabrizio ; Vallone, Stefano ; Bigliardi, Guido ; Zini, Andrea ; Vinci, Sergio Lucio ; Dell’Aera, Cristina ; Bracco, Sandra ; Cioni, Samuele ; Tassi, Rossana ; Bergui, Mauro ; Naldi, Andrea ; Carità, Giuseppe ; Azzini, Cristiano ; Casetta, Ilaria ; Gasparotti, Roberto ; Magoni, Mauro ; Castellan, Lucio ; Finocchi, Cinzia ; Menozzi, Roberto ; Scoditti, Umberto ; Causin, Francesco ; Viaro, Federica ; Puglielli, Edoardo ; Casalena, Alfonsina ; Ruggiero, Maria ; Biguzzi, Sara ; Castellano, Davide ; Cavallo, Roberto ; Lazzarotti, Guido Andrea ; Orlandi, Giovanni ; Sgreccia, Alessandro ; Denaro, Maria Federica ; Cavasin, Nicola ; Critelli, Adriana ; Ciceri, Elisa Francesca Maria ; Bonetti, Bruno ; Chiumarulo, Luigi ; Petruzzelli, Marco ; Pellegrino, Carlo ; Carimati, Federico ; Burdi, Nicola ; Prontera, Maria Pia ; Auteri, Wiliam ; Petrone, Alfredo ; Guidetti, Giulio ; Nicolini, Ettore ; Ganci, Giuseppe ; Sugo, Annalisa ; Filauri, Pietro ; Sacco, Simona ; Squassina, Guido ; Invernizzi, Paolo ; Nuzzi, Nunzio Paolo ; Corato, Manuel ; Amistà, Pietro ; Gentile, Mauro ; Barbero, Stefano ; Schirru, Federica ; Craparo, Giuseppe ; Mannino, Marina ; Simonetti, Luigi ; Mangiafico, Salvatore ; Toni, Danilo</creatorcontrib><description>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/mm
3
(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.</description><identifier>ISSN: 0340-5354</identifier><identifier>EISSN: 1432-1459</identifier><identifier>DOI: 10.1007/s00415-020-10098-w</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Cardiovascular system ; Death ; Endocarditis ; Hematoma ; Hemorrhage ; Heparin ; Liver diseases ; Medicine ; Medicine & Public Health ; Neurology ; Neuroradiology ; Neurosciences ; Occlusion ; Original Communication ; Stroke ; Thrombolysis</subject><ispartof>Journal of neurology, 2020-12, Vol.267 (12), p.3731-3740</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-69f2d2859d6d74b6283bf1c9917d2493b1cf9a8b3a4a3e9dca61115a32e38e103</citedby><cites>FETCH-LOGICAL-c396t-69f2d2859d6d74b6283bf1c9917d2493b1cf9a8b3a4a3e9dca61115a32e38e103</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00415-020-10098-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00415-020-10098-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids></links><search><creatorcontrib>Cappellari, Manuel</creatorcontrib><creatorcontrib>Pracucci, Giovanni</creatorcontrib><creatorcontrib>Forlivesi, Stefano</creatorcontrib><creatorcontrib>Saia, Valentina</creatorcontrib><creatorcontrib>Limbucci, Nicola</creatorcontrib><creatorcontrib>Nencini, Patrizia</creatorcontrib><creatorcontrib>Inzitari, Domenico</creatorcontrib><creatorcontrib>Da Ros, Valerio</creatorcontrib><creatorcontrib>Sallustio, Fabrizio</creatorcontrib><creatorcontrib>Vallone, Stefano</creatorcontrib><creatorcontrib>Bigliardi, Guido</creatorcontrib><creatorcontrib>Zini, Andrea</creatorcontrib><creatorcontrib>Vinci, Sergio Lucio</creatorcontrib><creatorcontrib>Dell’Aera, Cristina</creatorcontrib><creatorcontrib>Bracco, Sandra</creatorcontrib><creatorcontrib>Cioni, Samuele</creatorcontrib><creatorcontrib>Tassi, Rossana</creatorcontrib><creatorcontrib>Bergui, Mauro</creatorcontrib><creatorcontrib>Naldi, Andrea</creatorcontrib><creatorcontrib>Carità, Giuseppe</creatorcontrib><creatorcontrib>Azzini, Cristiano</creatorcontrib><creatorcontrib>Casetta, Ilaria</creatorcontrib><creatorcontrib>Gasparotti, Roberto</creatorcontrib><creatorcontrib>Magoni, Mauro</creatorcontrib><creatorcontrib>Castellan, Lucio</creatorcontrib><creatorcontrib>Finocchi, Cinzia</creatorcontrib><creatorcontrib>Menozzi, Roberto</creatorcontrib><creatorcontrib>Scoditti, Umberto</creatorcontrib><creatorcontrib>Causin, Francesco</creatorcontrib><creatorcontrib>Viaro, Federica</creatorcontrib><creatorcontrib>Puglielli, Edoardo</creatorcontrib><creatorcontrib>Casalena, Alfonsina</creatorcontrib><creatorcontrib>Ruggiero, Maria</creatorcontrib><creatorcontrib>Biguzzi, Sara</creatorcontrib><creatorcontrib>Castellano, Davide</creatorcontrib><creatorcontrib>Cavallo, Roberto</creatorcontrib><creatorcontrib>Lazzarotti, Guido Andrea</creatorcontrib><creatorcontrib>Orlandi, Giovanni</creatorcontrib><creatorcontrib>Sgreccia, Alessandro</creatorcontrib><creatorcontrib>Denaro, Maria Federica</creatorcontrib><creatorcontrib>Cavasin, Nicola</creatorcontrib><creatorcontrib>Critelli, Adriana</creatorcontrib><creatorcontrib>Ciceri, Elisa Francesca Maria</creatorcontrib><creatorcontrib>Bonetti, Bruno</creatorcontrib><creatorcontrib>Chiumarulo, Luigi</creatorcontrib><creatorcontrib>Petruzzelli, Marco</creatorcontrib><creatorcontrib>Pellegrino, Carlo</creatorcontrib><creatorcontrib>Carimati, Federico</creatorcontrib><creatorcontrib>Burdi, Nicola</creatorcontrib><creatorcontrib>Prontera, Maria Pia</creatorcontrib><creatorcontrib>Auteri, Wiliam</creatorcontrib><creatorcontrib>Petrone, Alfredo</creatorcontrib><creatorcontrib>Guidetti, Giulio</creatorcontrib><creatorcontrib>Nicolini, Ettore</creatorcontrib><creatorcontrib>Ganci, Giuseppe</creatorcontrib><creatorcontrib>Sugo, Annalisa</creatorcontrib><creatorcontrib>Filauri, Pietro</creatorcontrib><creatorcontrib>Sacco, Simona</creatorcontrib><creatorcontrib>Squassina, Guido</creatorcontrib><creatorcontrib>Invernizzi, Paolo</creatorcontrib><creatorcontrib>Nuzzi, Nunzio Paolo</creatorcontrib><creatorcontrib>Corato, Manuel</creatorcontrib><creatorcontrib>Amistà, Pietro</creatorcontrib><creatorcontrib>Gentile, Mauro</creatorcontrib><creatorcontrib>Barbero, Stefano</creatorcontrib><creatorcontrib>Schirru, Federica</creatorcontrib><creatorcontrib>Craparo, Giuseppe</creatorcontrib><creatorcontrib>Mannino, Marina</creatorcontrib><creatorcontrib>Simonetti, Luigi</creatorcontrib><creatorcontrib>Mangiafico, Salvatore</creatorcontrib><creatorcontrib>Toni, Danilo</creatorcontrib><title>Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis</title><title>Journal of neurology</title><addtitle>J Neurol</addtitle><description>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/mm
3
(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.</description><subject>Cardiovascular system</subject><subject>Death</subject><subject>Endocarditis</subject><subject>Hematoma</subject><subject>Hemorrhage</subject><subject>Heparin</subject><subject>Liver diseases</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosciences</subject><subject>Occlusion</subject><subject>Original Communication</subject><subject>Stroke</subject><subject>Thrombolysis</subject><issn>0340-5354</issn><issn>1432-1459</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kE1LxDAQhoMouK7-AU8BL16i-epHjrJ-woIXvRrSdKpZ22ZNWtb998atIHjwNDPM874zvAidMnrBKC0uI6WSZYRyStKsSrLZQzMmBSdMZmofzaiQlGQik4foKMYVpbRMixl6uXYB7ICHt-C7KnW-2-LGBxyH4N8Buz6tAK8DROgtYN9gU0XfjgNg-LTtGJ3vsQ1ugODMTjlZ-XYbXTxGB41pI5z81Dl6vr15WtyT5ePdw-JqSaxQ-UBy1fCal5mq87qQVc5LUTXMKsWKmkslKmYbZcpKGGkEqNqanDGWGcFBlMComKPzyXcd_McIcdCdixba1vTgx6i55EXGMy7KhJ79QVd-DH36TqezBWdcyCJRfKJs8DEGaPQ6uM6ErWZUf0eup8h1ilzvItebJBKTKCa4f4Xwa_2P6guj-oVN</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Cappellari, Manuel</creator><creator>Pracucci, Giovanni</creator><creator>Forlivesi, Stefano</creator><creator>Saia, Valentina</creator><creator>Limbucci, Nicola</creator><creator>Nencini, Patrizia</creator><creator>Inzitari, Domenico</creator><creator>Da Ros, Valerio</creator><creator>Sallustio, Fabrizio</creator><creator>Vallone, Stefano</creator><creator>Bigliardi, Guido</creator><creator>Zini, Andrea</creator><creator>Vinci, Sergio Lucio</creator><creator>Dell’Aera, Cristina</creator><creator>Bracco, Sandra</creator><creator>Cioni, Samuele</creator><creator>Tassi, Rossana</creator><creator>Bergui, Mauro</creator><creator>Naldi, Andrea</creator><creator>Carità, Giuseppe</creator><creator>Azzini, Cristiano</creator><creator>Casetta, Ilaria</creator><creator>Gasparotti, Roberto</creator><creator>Magoni, Mauro</creator><creator>Castellan, Lucio</creator><creator>Finocchi, Cinzia</creator><creator>Menozzi, Roberto</creator><creator>Scoditti, Umberto</creator><creator>Causin, Francesco</creator><creator>Viaro, Federica</creator><creator>Puglielli, Edoardo</creator><creator>Casalena, Alfonsina</creator><creator>Ruggiero, Maria</creator><creator>Biguzzi, Sara</creator><creator>Castellano, Davide</creator><creator>Cavallo, Roberto</creator><creator>Lazzarotti, Guido Andrea</creator><creator>Orlandi, Giovanni</creator><creator>Sgreccia, Alessandro</creator><creator>Denaro, Maria Federica</creator><creator>Cavasin, Nicola</creator><creator>Critelli, Adriana</creator><creator>Ciceri, Elisa Francesca Maria</creator><creator>Bonetti, Bruno</creator><creator>Chiumarulo, Luigi</creator><creator>Petruzzelli, Marco</creator><creator>Pellegrino, Carlo</creator><creator>Carimati, Federico</creator><creator>Burdi, Nicola</creator><creator>Prontera, Maria Pia</creator><creator>Auteri, Wiliam</creator><creator>Petrone, Alfredo</creator><creator>Guidetti, Giulio</creator><creator>Nicolini, Ettore</creator><creator>Ganci, Giuseppe</creator><creator>Sugo, Annalisa</creator><creator>Filauri, Pietro</creator><creator>Sacco, Simona</creator><creator>Squassina, Guido</creator><creator>Invernizzi, Paolo</creator><creator>Nuzzi, Nunzio Paolo</creator><creator>Corato, Manuel</creator><creator>Amistà, Pietro</creator><creator>Gentile, Mauro</creator><creator>Barbero, Stefano</creator><creator>Schirru, Federica</creator><creator>Craparo, Giuseppe</creator><creator>Mannino, Marina</creator><creator>Simonetti, Luigi</creator><creator>Mangiafico, Salvatore</creator><creator>Toni, Danilo</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20201201</creationdate><title>Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis</title><author>Cappellari, Manuel ; Pracucci, Giovanni ; Forlivesi, Stefano ; Saia, Valentina ; Limbucci, Nicola ; Nencini, Patrizia ; Inzitari, Domenico ; Da Ros, Valerio ; Sallustio, Fabrizio ; Vallone, Stefano ; Bigliardi, Guido ; Zini, Andrea ; Vinci, Sergio Lucio ; Dell’Aera, Cristina ; Bracco, Sandra ; Cioni, Samuele ; Tassi, Rossana ; Bergui, Mauro ; Naldi, Andrea ; Carità, Giuseppe ; Azzini, Cristiano ; Casetta, Ilaria ; Gasparotti, Roberto ; Magoni, Mauro ; Castellan, Lucio ; Finocchi, Cinzia ; Menozzi, Roberto ; Scoditti, Umberto ; Causin, Francesco ; Viaro, Federica ; Puglielli, Edoardo ; Casalena, Alfonsina ; Ruggiero, Maria ; Biguzzi, Sara ; Castellano, Davide ; Cavallo, Roberto ; Lazzarotti, Guido Andrea ; Orlandi, Giovanni ; Sgreccia, Alessandro ; Denaro, Maria Federica ; Cavasin, Nicola ; Critelli, Adriana ; Ciceri, Elisa Francesca Maria ; Bonetti, Bruno ; Chiumarulo, Luigi ; Petruzzelli, Marco ; Pellegrino, Carlo ; Carimati, Federico ; Burdi, Nicola ; Prontera, Maria Pia ; Auteri, Wiliam ; Petrone, Alfredo ; Guidetti, Giulio ; Nicolini, Ettore ; Ganci, Giuseppe ; Sugo, Annalisa ; Filauri, Pietro ; Sacco, Simona ; Squassina, Guido ; Invernizzi, Paolo ; Nuzzi, Nunzio Paolo ; Corato, Manuel ; Amistà, Pietro ; Gentile, Mauro ; Barbero, Stefano ; Schirru, Federica ; Craparo, Giuseppe ; Mannino, Marina ; Simonetti, Luigi ; Mangiafico, Salvatore ; Toni, Danilo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-69f2d2859d6d74b6283bf1c9917d2493b1cf9a8b3a4a3e9dca61115a32e38e103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Cardiovascular system</topic><topic>Death</topic><topic>Endocarditis</topic><topic>Hematoma</topic><topic>Hemorrhage</topic><topic>Heparin</topic><topic>Liver diseases</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosciences</topic><topic>Occlusion</topic><topic>Original Communication</topic><topic>Stroke</topic><topic>Thrombolysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cappellari, Manuel</creatorcontrib><creatorcontrib>Pracucci, Giovanni</creatorcontrib><creatorcontrib>Forlivesi, Stefano</creatorcontrib><creatorcontrib>Saia, Valentina</creatorcontrib><creatorcontrib>Limbucci, Nicola</creatorcontrib><creatorcontrib>Nencini, Patrizia</creatorcontrib><creatorcontrib>Inzitari, Domenico</creatorcontrib><creatorcontrib>Da Ros, Valerio</creatorcontrib><creatorcontrib>Sallustio, Fabrizio</creatorcontrib><creatorcontrib>Vallone, Stefano</creatorcontrib><creatorcontrib>Bigliardi, Guido</creatorcontrib><creatorcontrib>Zini, Andrea</creatorcontrib><creatorcontrib>Vinci, Sergio Lucio</creatorcontrib><creatorcontrib>Dell’Aera, Cristina</creatorcontrib><creatorcontrib>Bracco, Sandra</creatorcontrib><creatorcontrib>Cioni, Samuele</creatorcontrib><creatorcontrib>Tassi, Rossana</creatorcontrib><creatorcontrib>Bergui, Mauro</creatorcontrib><creatorcontrib>Naldi, Andrea</creatorcontrib><creatorcontrib>Carità, Giuseppe</creatorcontrib><creatorcontrib>Azzini, Cristiano</creatorcontrib><creatorcontrib>Casetta, Ilaria</creatorcontrib><creatorcontrib>Gasparotti, Roberto</creatorcontrib><creatorcontrib>Magoni, Mauro</creatorcontrib><creatorcontrib>Castellan, Lucio</creatorcontrib><creatorcontrib>Finocchi, Cinzia</creatorcontrib><creatorcontrib>Menozzi, Roberto</creatorcontrib><creatorcontrib>Scoditti, Umberto</creatorcontrib><creatorcontrib>Causin, Francesco</creatorcontrib><creatorcontrib>Viaro, Federica</creatorcontrib><creatorcontrib>Puglielli, Edoardo</creatorcontrib><creatorcontrib>Casalena, Alfonsina</creatorcontrib><creatorcontrib>Ruggiero, Maria</creatorcontrib><creatorcontrib>Biguzzi, Sara</creatorcontrib><creatorcontrib>Castellano, Davide</creatorcontrib><creatorcontrib>Cavallo, Roberto</creatorcontrib><creatorcontrib>Lazzarotti, Guido Andrea</creatorcontrib><creatorcontrib>Orlandi, Giovanni</creatorcontrib><creatorcontrib>Sgreccia, Alessandro</creatorcontrib><creatorcontrib>Denaro, Maria Federica</creatorcontrib><creatorcontrib>Cavasin, Nicola</creatorcontrib><creatorcontrib>Critelli, Adriana</creatorcontrib><creatorcontrib>Ciceri, Elisa Francesca Maria</creatorcontrib><creatorcontrib>Bonetti, Bruno</creatorcontrib><creatorcontrib>Chiumarulo, Luigi</creatorcontrib><creatorcontrib>Petruzzelli, Marco</creatorcontrib><creatorcontrib>Pellegrino, Carlo</creatorcontrib><creatorcontrib>Carimati, Federico</creatorcontrib><creatorcontrib>Burdi, Nicola</creatorcontrib><creatorcontrib>Prontera, Maria Pia</creatorcontrib><creatorcontrib>Auteri, Wiliam</creatorcontrib><creatorcontrib>Petrone, Alfredo</creatorcontrib><creatorcontrib>Guidetti, Giulio</creatorcontrib><creatorcontrib>Nicolini, Ettore</creatorcontrib><creatorcontrib>Ganci, Giuseppe</creatorcontrib><creatorcontrib>Sugo, Annalisa</creatorcontrib><creatorcontrib>Filauri, Pietro</creatorcontrib><creatorcontrib>Sacco, Simona</creatorcontrib><creatorcontrib>Squassina, Guido</creatorcontrib><creatorcontrib>Invernizzi, Paolo</creatorcontrib><creatorcontrib>Nuzzi, Nunzio Paolo</creatorcontrib><creatorcontrib>Corato, Manuel</creatorcontrib><creatorcontrib>Amistà, Pietro</creatorcontrib><creatorcontrib>Gentile, Mauro</creatorcontrib><creatorcontrib>Barbero, Stefano</creatorcontrib><creatorcontrib>Schirru, Federica</creatorcontrib><creatorcontrib>Craparo, Giuseppe</creatorcontrib><creatorcontrib>Mannino, Marina</creatorcontrib><creatorcontrib>Simonetti, Luigi</creatorcontrib><creatorcontrib>Mangiafico, Salvatore</creatorcontrib><creatorcontrib>Toni, Danilo</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cappellari, Manuel</au><au>Pracucci, Giovanni</au><au>Forlivesi, Stefano</au><au>Saia, Valentina</au><au>Limbucci, Nicola</au><au>Nencini, Patrizia</au><au>Inzitari, Domenico</au><au>Da Ros, Valerio</au><au>Sallustio, Fabrizio</au><au>Vallone, Stefano</au><au>Bigliardi, Guido</au><au>Zini, Andrea</au><au>Vinci, Sergio Lucio</au><au>Dell’Aera, Cristina</au><au>Bracco, Sandra</au><au>Cioni, Samuele</au><au>Tassi, Rossana</au><au>Bergui, Mauro</au><au>Naldi, Andrea</au><au>Carità, Giuseppe</au><au>Azzini, Cristiano</au><au>Casetta, Ilaria</au><au>Gasparotti, Roberto</au><au>Magoni, Mauro</au><au>Castellan, Lucio</au><au>Finocchi, Cinzia</au><au>Menozzi, Roberto</au><au>Scoditti, Umberto</au><au>Causin, Francesco</au><au>Viaro, Federica</au><au>Puglielli, Edoardo</au><au>Casalena, Alfonsina</au><au>Ruggiero, Maria</au><au>Biguzzi, Sara</au><au>Castellano, Davide</au><au>Cavallo, Roberto</au><au>Lazzarotti, Guido Andrea</au><au>Orlandi, Giovanni</au><au>Sgreccia, Alessandro</au><au>Denaro, Maria Federica</au><au>Cavasin, Nicola</au><au>Critelli, Adriana</au><au>Ciceri, Elisa Francesca Maria</au><au>Bonetti, Bruno</au><au>Chiumarulo, Luigi</au><au>Petruzzelli, Marco</au><au>Pellegrino, Carlo</au><au>Carimati, Federico</au><au>Burdi, Nicola</au><au>Prontera, Maria Pia</au><au>Auteri, Wiliam</au><au>Petrone, Alfredo</au><au>Guidetti, Giulio</au><au>Nicolini, Ettore</au><au>Ganci, Giuseppe</au><au>Sugo, Annalisa</au><au>Filauri, Pietro</au><au>Sacco, Simona</au><au>Squassina, Guido</au><au>Invernizzi, Paolo</au><au>Nuzzi, Nunzio Paolo</au><au>Corato, Manuel</au><au>Amistà, Pietro</au><au>Gentile, Mauro</au><au>Barbero, Stefano</au><au>Schirru, Federica</au><au>Craparo, Giuseppe</au><au>Mannino, Marina</au><au>Simonetti, Luigi</au><au>Mangiafico, Salvatore</au><au>Toni, Danilo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis</atitle><jtitle>Journal of neurology</jtitle><stitle>J Neurol</stitle><date>2020-12-01</date><risdate>2020</risdate><volume>267</volume><issue>12</issue><spage>3731</spage><epage>3740</epage><pages>3731-3740</pages><issn>0340-5354</issn><eissn>1432-1459</eissn><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/mm
3
(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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00415-020-10098-w</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0340-5354 |
| ispartof | Journal of neurology, 2020-12, Vol.267 (12), p.3731-3740 |
| issn | 0340-5354 1432-1459 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2427525238 |
| source | SpringerLink Journals - AutoHoldings |
| subjects | Cardiovascular system Death Endocarditis Hematoma Hemorrhage Heparin Liver diseases Medicine Medicine & Public Health Neurology Neuroradiology Neurosciences Occlusion Original Communication Stroke Thrombolysis |
| title | Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis |
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