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Observational Study
. 2025 Apr 2;272(4):308.
doi: 10.1007/s00415-025-13026-y.

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

Ilaria Casetta  1 , Giovanni Pracucci  2 , Valentina Saia  3 , Enrico Fainardi  4 , Fabrizio Sallustio  5 , Bruno Del Sette  6 , Tiziana Benzi Markushi  6 , Orazio Buonomo  7 , Ludovica Ferraù  7 , Mauro Bergui  8 , Paolo Cerrato  9 , Sandra Bracco  10 , Rossana Tassi  10 , Stefano Vallone  11 , Guido Bigliardi  11 , Guido A Lazzarotti  12 , Nicola Giannini  12 , Leonardo Renieri  13 , Patrizia Nencini  14 , Daniele Romano  15 , Rosa Napoletano  15 , Simone Galluzzo  16 , Andrea Zini  16 , Roberto Menozzi  17 , Alessandro Pezzini  17 , Nicolò Mandruzzato  18 , Manuel Cappellari  18 , Maria Ruggiero  19 , Marco Longoni  19 , Sergio Nappini  20 , Federico Mazzacane  20 , Nicola Burdi  21 , Giovanni Boero  21 , Nicola Cavasin  22 , Adriana Critelli  22 , Andrea Calzoni  3 , Tiziana Tassinari  3 , Andrea Saletti  23 , Cristiano Azzini  23 , Valerio Da Ros  5 , Giordano Lacidogna  5 , Domenico S Zimatore  24 , Marco Petruzzellis  24 , Davide Castellano  25 , Andrea Naldi  25 , Francesco Biraschi  26 , Ettore Nicolini  26 , Alessio Comai  27 , Elisa Dall' Ora  27 , Emilio Lozupone  28 , Marcella Caggiula  28 , Ivan Gallesio  29 , Delfina Ferrandi  29 , Marco Perri  30 , Simona Sacco  31 , Michele Besana  32 , Alessia Giossi  32 , Giuseppe Carità  33 , Monia Russo  33 , Gianluca Galvano  34 , Eleonora Saracco  34 , Marco Pavia  35 , Paolo Invernizzi  35 , Marco Filizzolo  36 , Marina Mannino  37 , Edoardo Puglielli  38 , Alfonsina Casalena  38 , Salvatore Mangiafico #  39 , Danilo Toni #  26 ; IRETAS group
Affiliations
Observational Study

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

Ilaria Casetta et al. J Neurol. .

Abstract

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.

Keywords: Etiology; Ischemic stroke; Large vessel occlusion; Thrombectomy.

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Conflict of interest statement

Declarations. Conflict of interest: Other authors declare no conflicts of interest. Disclosures: AZp declares consulting fees from Boehringer-Ingelheim, Bayer, Alexion and CLS Behring. MCr Consultancy or advisory board fees or speaker's honoraria from Pfizer/Bristol Meyer Squibb and Daiichi Sankyo. SSee Personal fees as speaker or advisor: Abbott, Allergan-Abbvie, AstraZeneca, Boheringer, Eli Lilly, Lundbeck, Novartis, NovoNordisk, Pfizer, Teva. Research grants: Novartis, Uriach. MRgg received grants from Novartis and Uriach. Ethics approval and informed consent: The present study was in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Need for ethical approval or patient consent for participation in the IRETAS varied among participating hospitals. Informed consent to the use of anonymized and aggregated data for participation in the IRETAS (Italian Registry of Endovascular Treatment in Acute Stroke) was obtained from all patients of each center.

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