Clinical Study Of Endovascular Thrombectomy In Treating Acute Ischemic Stroke Due To Cervical Artery Dissection

Cervical artery dissection is a relatively rare disease,but is one of the most common causes of young stroke.Traditional medical treatment for cervical artery dissection with large artery occlusion often leads to poorer prognosis.The safety and efficacy of intravenous thrombolysis for cervical artery dissection are still controversial.Therefore,more aggressive and more efficacious treatments may be needed in these patients.Endovascular thrombectomy combined with intravenous thrombolysis has become the first-line treatment strategy for acute ischemic stroke(AIS)with large vessel occlusion in anterior circulation.Previous studies have shown that direct thrombectomy can achieve anequal clinical prognosis as bridging therapyin treating acute ischemic stroke with large artery occlusion(LAO)in anterior circulation.However,the safety and efficacy of endovascular thrombectomy for cervical artery dissection have not been proved.Therefore,this study aims to evaluate the safety and efficacy of endovascular thrombectomy in treatingacute ischemic stroke with large artery occlusionin anterior circulation because of cervical artery dissection.Secondly,this study compared the clinical efficacy of direct thrombectomy and bridging thrombectomy in treatingacute ischemic stroke with large artery occlusion in anterior circulation due to cervical artery dissection.Part oneFeasibility of Thrombectomy in Treating Acute Ischemic Stroke because of Cervical Artery DissectionBackground and Purpose—Acute ischemic stroke with large artery occlusion in anterior circulation due to cervical artery dissection usually have unfavorable outcomes dispite approprnate medical treatment.This study evaluated the safety and efficacy of endovascular thrombectomy in treating acute ischemic stroke due to cervical artery dissection.Materials and Methods—Patients with acute ischemic stroke and with large artery occlusion associated with cervical artery dissection were selected.Baseline characteristics and clinical outcomes were compared between patients with and without thrombectomy.Propensity score match was performed to increase the comparability.Patients with a 90-day modified Rankin Scale(mRS)score of 0-2 was defined as with favorable outcome.Results—A total of 160 patients were enrolled,80(50.0%)patients were treated withand the rest of 80(50.0%)patients without thrombectomy.After propensity score matching,48 patients with thrombectomy and 48 patients without thrombectomy were selected for further analysis.Proportion of favorable outcome(mRS 0-2)was higher in patients with thrombectomy than in those without thrombectomy(66.7%versus 39.6%,P=0.008).Proportion of symptomatic intracranial hemorrhage(sICH)was higher in patients with than in those without thrombectomy,but no significance differences were found between matched patients with and without thrombectomy(8.3%versus 4.2%,P=0.677).The incidence of the 90-day mortality was higher in patients with than in those without thrombectomy,but no significance difference was found between matched patients with and without thrombectomy(10.4%versus 6.3%,P=0.714).Conclusions—Endovascular thrombectomy seems to be an effective and safe treatment in selected patients with acute ischemic stroke associated with cervical artery dissection.Randomized controlled trials are warranted to confirm this observational result in the future.Part twoDirect Endovascular Thrombectomy Versus Bridging Thrombectomy in Acute Ischemic Stroke due to Cervical Artery DissectionBackbround and Purpose—Direct thrombectomy seems to be as effective as bridging thrombectomy(intravenous thrombolysis combined with thrombectomy)in treating acute large artery occlusion in anterior circulation.Intravenous thrombolysis is controversial in treating cervical artery dissection.This study aims to compare direct mechanical thrombectomy with bridging thrombectomy in treating acute ischemic stroke due to cervical artery dissection.Materials and Methods-Patients with acute ischemic stroke and with large artery occlusion associated with cervical artery dissection were selected.Baseline characteristics and clinical outcomes were compared between patients treating with direct thrombectomy and patients with bridging thrombectomy.Patients with a modified thrombolysis in cerebral infarction of 2b or 3(mTICI 2b-3)was defined as with successful recanalization.Patients with a 90-day modified Rankin Scale(mRS)score of 0-2 was defined as with favorable outcome.Results—A total of 81 patients were enrolled,32 were treated with bridging thrombectomy and 49 were treating with direct thrombectomy.Patients with direct thrombectomy have a shorter imaging to puncture(FTP)times(73min versus 112min,P=0.005)and a shorter symptom onset to recanalization(335min versus 399min,P=0.024)than patients with bridging thrombectomy.There were no significance differences in favorable outcome at 90-day(mRS 0-2)between patients with direct thrombectomy and patients with bridging thrombectomy(59.2%versus 65.6%,P=0.560).There were no significance differences concerning the incidence of symptomatic intracranial hemorrhage(6.1%versus 6.3%,P=1.000)and the 90-day mortality(8.2%versus 9.4%,P=1.000)between patients with directthrombectomy group and patients with bridging thrombectomy group.Conclusions—Direct thrombectomy seems to be equally effective as bridging thrombectomy in patients with acute ischemic stroke due to cervical artery dissection.Randomized controlled trials are warranted to confirm this observational result.