Recanalization Therapies for Large Vessel Occlusion Due to Cervical Artery Dissection: A Cohort Study of the EVA-TRISP Collaboration

Christopher Traenka; Johannes Lorscheider; Christian Hametner; Philipp Baumgartner; Jan Gralla; Mauro Magoni; Nicolas Martinez-Majander; Barbara Casolla; Katharina Feil; Rosario Pascarella; Panagiotis Papanagiotou; Annika Nordanstig; Visnja Padjen; Carlo W Cereda; Marios Psychogios; Christian H Nolte; Andrea Zini; Patrik Michel; Yannick Béjot; Andreas Kastrup; Marialuisa Zedde; Georg Kägi; Lars Kellert; Hilde Henon; Sami Curtze; Alessandro Pezzini; Marcel Arnold; Susanne Wegener; Peter Ringleb; Turgut Tatlisumak; Paul J Nederkoorn; Stefan T Engelter; Henrik Gensicke; EVA-TRISP Collaborators

doi:10.5853/jos.2022.03370

Recanalization Therapies for Large Vessel Occlusion Due to Cervical Artery Dissection: A Cohort Study of the EVA-TRISP Collaboration

J Stroke. 2023 May;25(2):272-281. doi: 10.5853/jos.2022.03370. Epub 2023 May 30.

Authors

Christopher Traenka^{1

2}, Johannes Lorscheider^{1

3}, Christian Hametner⁴, Philipp Baumgartner⁵, Jan Gralla⁶, Mauro Magoni⁷, Nicolas Martinez-Majander⁸, Barbara Casolla^{9

10}, Katharina Feil^{11

12}, Rosario Pascarella¹³, Panagiotis Papanagiotou¹⁴, Annika Nordanstig¹⁵, Visnja Padjen¹⁶, Carlo W Cereda¹⁷, Marios Psychogios^{1

18}, Christian H Nolte¹⁹, Andrea Zini²⁰, Patrik Michel²¹, Yannick Béjot²², Andreas Kastrup¹⁴, Marialuisa Zedde²³, Georg Kägi^{24

25}, Lars Kellert¹¹, Hilde Henon⁹, Sami Curtze⁸, Alessandro Pezzini²⁶, Marcel Arnold²⁵, Susanne Wegener⁵, Peter Ringleb⁴, Turgut Tatlisumak¹⁵, Paul J Nederkoorn²⁷, Stefan T Engelter^{1

2}, Henrik Gensicke^{1

2}; EVA-TRISP Collaborators¹

Affiliations

¹ Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
² Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland.
³ Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
⁴ Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
⁵ Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
⁶ Institute of Diagnostic and Interventional Neuroradiology University Hospital Bern, University of Bern, Bern, Switzerland.
⁷ ASST Spedali Civili, Neurologia Vascolare, Brescia, Italy.
⁸ Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁹ Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France.
¹⁰ Stroke Unit, UR2CA-URRIS Neurology, CHU Pasteur 2, Nice Cote d'Azur University, Nice, France.
¹¹ Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany.
¹² Department of Neurology, University Hospital Tübingen, Tübingen, Germany.
¹³ Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
¹⁴ Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany.
¹⁵ Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁶ University of Belgrade, Faculty of Medicine, Neurology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia.
¹⁷ Stroke Center, Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.
¹⁸ Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
¹⁹ Klinik für Neurologie mit experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany.
²⁰ IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy.
²¹ Stroke Service, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.
²² Department of Neurology, University Hospital Dijon, Dijon, France.
²³ Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
²⁴ Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
²⁵ Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
²⁶ Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy.
²⁷ Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.

Abstract

Background and purpose: This study aimed to investigate the effect of endovascular treatment (EVT, with or without intravenous thrombolysis [IVT]) versus IVT alone on outcomes in patients with acute ischemic stroke (AIS) and intracranial large vessel occlusion (LVO) attributable to cervical artery dissection (CeAD).

Methods: This multinational cohort study was conducted based on prospectively collected data from the EVA-TRISP (EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients) collaboration. Consecutive patients (2015-2019) with AIS-LVO attributable to CeAD treated with EVT and/or IVT were included. Primary outcome measures were (1) favorable 3-month outcome (modified Rankin Scale score 0-2) and (2) complete recanalization (thrombolysis in cerebral infarction scale 2b/3). Odds ratios with 95% confidence intervals (OR [95% CI]) from logistic regression models were calculated (unadjusted, adjusted). Secondary analyses were performed in the patients with LVO in the anterior circulation (LVOant) including propensity score matching.

Results: Among 290 patients, 222 (76.6%) had EVT and 68 (23.4%) IVT alone. EVT-treated patients had more severe strokes (National Institutes of Health Stroke Scale score, median [interquartile range]: 14 [10-19] vs. 4 [2-7], P<0.001). The frequency of favorable 3-month outcome did not differ significantly between both groups (EVT: 64.0% vs. IVT: 86.8%; ORadjusted 0.56 [0.24-1.32]). EVT was associated with higher rates of recanalization (80.5% vs. 40.7%; ORadjusted 8.85 [4.28-18.29]) compared to IVT. All secondary analyses showed higher recanalization rates in the EVT-group, which however never translated into better functional outcome rates compared to the IVT-group.

Conclusion: We observed no signal of superiority of EVT over IVT regarding functional outcome in CeAD-patients with AIS and LVO despite higher rates of complete recanalization with EVT. Whether pathophysiological CeAD-characteristics or their younger age might explain this observation deserves further research.

Keywords: Cervical artery dissection; Endovascular treatment; Stroke; Thrombolysis.