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Updated: May 22, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Functional Outcome in Patients With Carotid Artery Dissection Undergoing Thrombectomy or Standard Medical Treatment
Marek Sykora1, Sven Poli2, Michael Giannakakis3
1Department of Neurology, St. John's Hospital and Sigmund Freud University Vienna, Austria.
Insights
Mechanical thrombectomy improved outcomes for stroke patients with carotid artery dissection and severe symptoms (NIHSS ≥6). However, it did not benefit those with milder symptoms (NIHSS <6).
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Carotid artery dissection (CAD) can cause ischemic stroke, often due to large vessel occlusion (LVO).
- The efficacy of mechanical thrombectomy versus best medical treatment (BMT) in CAD-related stroke is not well-established.
- Stroke severity, measured by the NIH Stroke Scale (NIHSS), may influence treatment outcomes.
Purpose of the Study:
- To compare the effectiveness of mechanical thrombectomy against BMT in patients with LVO secondary to CAD.
- To investigate the impact of admission stroke severity (NIHSS score) on treatment outcomes.
Main Methods:
- International observational study utilizing prospective stroke registries from Austria, Germany, and Switzerland.
- Comparison of patients with LVO due to CAD treated with thrombectomy versus BMT (including intravenous thrombolysis).
- Stratification of patients based on admission stroke severity: NIHSS <6 versus NIHSS ≥6. Primary outcome: modified Rankin Scale score of 0-2 at 3 months.
Main Results:
- A total of 1,023 patients were analyzed (516 thrombectomy, 507 BMT).
- Thrombectomy was associated with a favorable functional outcome in patients with severe stroke (NIHSS ≥6) (aRR = 1.77).
- Thrombectomy was associated with an unfavorable outcome in patients with mild stroke (NIHSS <6) (aRR = 1.68).
Conclusions:
- Mechanical thrombectomy significantly improves functional outcomes for patients with LVO due to CAD and severe stroke (NIHSS ≥6).
- Thrombectomy did not demonstrate a benefit for patients with mild stroke (NIHSS <6) due to CAD.
- This study provides Class III evidence supporting thrombectomy for severe CAD-related LVO stroke.
Background And Objectives:
Whether thrombectomy compared with best medical treatment (BMT) improves outcome in patients with stroke and carotid artery dissection (CAD) is unknown.
Methods:
This was an international observational study based on prospective nationwide Austrian, German, and Swiss stroke registries. Patients with large vessel occlusion (LVO) due to CAD were compared according to treatment modality (thrombectomy vs BMT including intravenous thrombolysis) and to admission stroke severity NIH Stroke Scale (NIHSS) <6 vs NIHSS ≥6. The primary outcome was the favorable functional outcome (modified Rankin Score 0-2) at 3 months.
Results:
Of 1,023 patients (mean age 54 years, 72% males), 516 received thrombectomy and 507 received BMT. After robust adjustment, thrombectomy was associated with favorable outcome in patients presenting with NIHSS ≥6 (adjusted risk ratio (aRR) = 1.77, 95% CI 1.44-2.17). In those presenting with NIHSS <6, thrombectomy was associated with unfavorable outcome (aRR 1.68, CI 1.1-2.56) as compared with BMT.
Discussion:
Thrombectomy improved functional outcome in patients with LVO due to CAD and admission NIHSS ≥6, but not NIHSS <6 points.
Classification Of Evidence:
This study provides Class III evidence that for patients with LVO due to CAD and admission NIHSS ≥6 points, thrombectomy compared with BMT significantly increases the probability of favorable outcome.
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