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. 2021 Aug 23:12:706130.
doi: 10.3389/fneur.2021.706130. eCollection 2021.

Stent Retriever Thrombectomy for Anterior vs. Posterior Circulation Ischemic Stroke: Analysis of the STRATIS Registry

Reza Jahan  1 , David S Liebeskind  2 , Osama O Zaidat  3 , Nils H Mueller-Kronast  4 , Michael T Froehler  5 , Jeffrey L Saver  2
Affiliations

Stent Retriever Thrombectomy for Anterior vs. Posterior Circulation Ischemic Stroke: Analysis of the STRATIS Registry

Reza Jahan et al. Front Neurol. .

Abstract

Background and Purpose: The benefits of mechanical thrombectomy (MT) in vertebrobasilar artery occlusions have not been well-studied. We compared clinical, procedural, and safety outcomes of MT for posterior circulation (PC) vs. anterior circulation (AC) occlusions among patients in the STRATIS registry. Methods: Data from STRATIS including patient demographics, procedural characteristics, and outcomes including symptomatic intracranial hemorrhage (sICH) at 24 h, serious adverse events (SAE), substantial reperfusion [modified thrombolysis in cerebral infarction (mTICI) 2b/3], 90-day functional independence [modified Rankin Scale (mRS) 0-2], and 90-day mortality were analyzed. Univariate logistic regression was used to calculate predictors of good clinical outcome. Results: Of 984 STRATIS patients, 43 (4.4%) patients with PC occlusions [mean age 63.0 ± 13.6, 25.6% (11/43) female] and 932 (94.7%) with AC occlusions [mean age 68.5 ± 14.8, 46.9% (437/932) female] were included for analysis. Median National Institutes of Health Stroke Scale (NIHSS) scores at baseline were 17.0 (13.0, 12.0) for the AC group and 12.0 (11.0, 24.0) for the PC group. Time from onset to procedure end was longer for the PC group [median (IQR): 322.0 min (255.0-421.0) vs. 271.0 min (207.0-360.0); p = 0.007]. PC and AC groups had similar rates of substantial reperfusion [89.2% (33/37) vs. 87.7% (684/780)], procedure-related SAE [0.0% (0/43) vs. 1.7% (16/932)], sICH [0.0% (0/38) vs. 1.5% (12/795)], 90-day functional independence [66.7% (26/39) vs. 55.9% (480/858)] and mortality [12.8% (5/39) vs. 15.8% (136/861)]. National Institutes of Health Stroke Scale score and patient sex were significant univariate predictors of good clinical outcome (p < 0.05). Conclusions: Despite longer reperfusion times, MT in PC stroke has similar rates of 90-day functional independence with no significant difference in procedure-related SAE, sICH, or mortality, supporting the use of MT in PC acute ischemic stroke (AIS). Clinical Trial Registration:https://www.clinicaltrials.gov, Identifier: NCT02239640.

Keywords: STRATIS registry; anterior circulation; ischemic stroke; mechanical thrombectomy; posterior circulation.

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Conflict of interest statement

RJ receives funding for his services as a scientific consultant regarding trial design and conduct to Medtronic/Covidien. DL serves as an imaging core lab consultant for Cerenovus, Genentech, Medtronic, and Stryker. OZ serves as a consultant for Neuravi/Cerenovus, Stryker, Penumbra, and Medtronic. NM-K serves as a scientific consultant regarding trial design and conduct to Medtronic. MF serves as a scientific consultant to Medtronic, Corindus, Balt, Cerenovus, Viz.ai, and Genentech, and has received research funding from the National Institutes of Health NIH, Stryker, Medtronic, Microvention, and Endophys. JS reports contracted hourly payments for service on clinical trial steering committee advising on rigorous trial design and conduct for Abbott, Medtronic, Stryker, and Cerenovus, and contracted stock options for service on clinical trial steering committee advising on rigorous trial design and conduct for Rapid Medical. The handling editor DH declared a past co-authorship/collaboration as part of large working groups with one of the authors OZ.

Figures

Figure 1
Figure 1
Adjusted clinical outcomes at 90 days based on mRS, presented as percentage of the total in anterior vs. posterior circulation patients. There is no significant difference between the two groups by shift analysis (P = 0.366 by Cochran-Mantel-Haenszel test).
See this image and copyright information in PMC

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