Ischemic Stroke, Vertebral Artery Ischemia, Arterial Occlusive Diseases, Vertebrobasilar Insufficiency
Conditions
Keywords
Prognosis, Revascularization, Treatment
Brief summary
Isolated vertebral artery occlusions (VAO) account for approximately one third of posterior circulation occlusions, but have been given the least attention among posterior circulation strokes. If the two recent ATTENTION and BAOCHE randomized clinical trials have proven the superiority of endovascular thrombectomy (EVT) in basilar artery occlusions, data on the effectiveness and harm of acute revascularization treatment on isolated VAO is scarce. We aim to investigate the impact of acute recanalisation treatments in acute ischemic stroke patients with isolated VAO. In the absence of RCT, observational data with appropriate statistical methods may give indications on benefits and harms of treating neglected stroke situations like acute vertebral occlusion. Results may also lay the basis for prospective studies, such as randomized clinical trials.
Interventions
Best medical treatment without intravenous thrombolysis nor endovascular thrombectomy
OTHERIntravenous thrombolysis (IVT)
Best medical treatment with intravenous thrombolysis but without endovascular thrombectomy
OTHEREndovascular thrombectomy (EVT) ± intravenous thrombolysis (IVT)
Best medical treatment with endovascular thrombectomy with or without intravenous thrombolysis
Sponsors
Asan Medical Center
St John of God Hospital, Vienna
Medical University Innsbruck
Hospital Vall d'Hebron
University Hospital, Basel, Switzerland
Clinical Centre of Serbia
Charite University, Berlin, Germany
Insel Gruppe AG, University Hospital Bern
Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
Boston Medical Center
Università degli Studi di Brescia
The Cooper Health System
University Hospital Carl Gustav Carus
Duke University
University Hospital, Geneva
Hadassah Medical Organization
Sahlgrenska University Hospital
Universitätsklinikum Hamburg-Eppendorf
Helsinki University Central Hospital
The University of Texas Health Science Center, Houston
University Hospital, Lille
Hospital de Egas Moniz
Neurocenter of Southern Switzerland
Corewell Health West
Azienda Ospedaliero-Universitaria di Modena
Ludwig-Maximilians - University of Munich
Azienda USL Reggio Emilia - IRCCS
University of Zurich
Centre Hospitalier Universitaire Vaudois
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Acute ischemic stroke limited to the posterior circulation * Presence of uni- or bilateral VAO (intracranial and/or extracranial) on at least one initial imaging study (CTA, MRA, DSA) * IVT, EVT or bridging-treated stroke patients between 01.01.2003 and 31.12.2021 * ≥ 18 years old
Exclusion criteria
* Extension of the occlusion into the basilar artery * Presence of a more distal occlusion in the pc (tandem occlusion/multilevel poster circulation occlusions) * Previously known chronic occlusion of the any segment of the vertebral artery/arteries * Local ethical/legal conditions in participating center not fulfilled
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 3-month modified Rankin scale | 90 days | 3-month functional outcome, \[range: 0-6, 0= no symptoms, 6=death\] |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| EVT procedural complications | During EVT procedure or peri-procedural | Any complication attributed to the procedure (vessel perforation, vasospasm, dissection, Subarachnoid haemorrhage (SAH)/Intracerebral haemorrhage (ICH), device detachment/misplacement, embolization to new territory, access-site complications, early reocclusion, other) |
| 24-hour NIHSS | 24 hours | NIH Stroke Scale/Score (NIHSS). Quantifies stroke severity based on weighted clinical evaluation findings at 24h. \[0-42, 0= no deficit, 42=maximum stroke severity\] |
| Early neurological deterioration (ENDi) | 24 hours | Early neurological deterioration of ischemic origin (ENDi) is defined as an increase in National Institute of Health Stroke (NIHSS) score ≥ 4 points or death within 24 hours. \[yes/no\] |
| Symptomatic intracerebral haemorrhage (sICH) | 7 days | Any hemorrhagic transformation temporally related to any worsening in neurological condition. \[yes/no\] |
| 24h and 3month mortality | 24h and 90 days | Mortality at 24h and 3 months |
| Vessel recanalisation on follow up-imaging | 48 hours | Vessel recanalisation at follow-up imaging (0= no recanalisation, 1= partial recanalisation 50-99%, 2=full recanalisation, 3= initially not occluded) |
| Cerebrovascular ischemic recurrences | 90 days | Any ischemic stroke or transient ischemic attack recurrence \[yes/no\] |
Countries
Switzerland
Outcome results
None listed