Mechanical thrombectomy in patients with cervical artery dissection and stroke in the anterior or posterior circulation - a multicenter analysis from the German Stroke Registry

Abstract

Background: Cervical artery dissection (CAD) is a rare cause of acute ischemic stroke (AIS) with large vessel occlusion (LVO) and may constitute a challenge for mechanical thrombectomy (MT). We compared procedural characteristics, reperfusion rates, and clinical outcome in AIS patients undergoing MT with and without CAD.

Methods: We performed a pre-specified analysis of patients registered within the German Stroke Registry, a prospectively maintained multicenter registry of consecutive patients with AIS patients treated by MT. Procedural characteristics included time periods and additional application of medication.

Results: Of 2589 patients, 62 (2.4%) were diagnosed with CAD. CAD patients were younger, had lower rates of known vascular risk factors and larger baseline stroke volumes. MT in CAD patients took significantly longer (median [IQR] groin-puncture-to-flow restoration time: 98 [67-136] versus 70 [45-100] minutes; p < 0.001) and more often required use of intra-arterial medication (34.4% versus 15.6%; p < 0.001). Reperfusion success (modified Treatment in Cerebral Infarction score 2b-3: 85.2% versus 83.3%, p = 0.690) and favorable functional outcome after 3 months (modified Rankin Scale score ≤ 2: 70.9% versus 36.4%, adjusted p = 0.086) did not differ significantly between patients with and without CAD. The latter findings held true for both CAD in the anterior and posterior circulation.

Conclusion: CAD in AIS requiring MT is rare. MT in patients with CAD constitutes a particular procedural challenge, but still achieves favorable radiological and functional outcomes in most patients. Our data provide indirect evidence that MT is of clinical benefit in patients with AIS due to LVO and CAD.

Keywords: Acute therapy; Dissection; Ischemic stroke; Mechanical thrombectomy; Registry.

Conflict of interest statement

LS reports lecture fees from Daiichi Sankyo, outside of the submitted work.

FF reports consulting fees from Eppdata, outside of the submitted work.

GCP reports consulting fees or fees as lecturer from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb and Pfizer, all outside of the submitted work.

GT reports consulting fees or fees as lecturer from Acandis, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Portola, Stryker, all outside of the submitted work.

ME reports grants from Bayer and fees paid to the Charité from Bayer, Boehringer Ingelheim, BMS/Pfizer, Daiichi Sankyo, Amgen, GSK, Sanofi, Covidien, and Novartis, all outside of the submitted work.

CHN reports consulting and lecture fess from Boehringer Ingelheim, W.L. Gore and Associates, Bristol-Myers Squibb, Pfizer, and Abbott, all outside of the submitted work.

The others have no disclosures.