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.

中文翻译：

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颈动脉夹层引起的大血管闭塞的再通疗法：EVA-TRISP 合作的队列研究。

背景和目的 本研究旨在探讨血管内治疗（EVT，伴或不伴静脉溶栓 [IVT]）与单纯 IVT 对急性缺血性卒中 (AIS) 和颅内大血管闭塞 (LVO) 患者结局的影响。动脉夹层 (CeAD)。方法 这项多国队列研究是根据前瞻性收集的 EVA-TRISP（缺血性卒中患者的血管内治疗和 ThRombolysis）合作数据进行的。纳入了连续接受 EVT 和/或 IVT 治疗的 CeAD 导致 AIS-LVO 的患者 (2015-2019)。主要结果指标是 (1) 良好的 3 个月结果（改良 Rankin 量表评分 0-2）和 (2) 完全再通（脑梗死溶栓量表 2b/3）。计算逻辑回归模型的优势比和 95% 置信区间 (OR [95% CI])（未调整、调整）。对前循环 LVO (LVOant) 患者进行了二次分析，包括倾向评分匹配。结果 在 290 名患者中，222 名 (76.6%) 有 EVT，68 名 (23.4%) 仅有 IVT。接受 EVT 治疗的患者中风更严重（美国国立卫生研究院中风量表评分，中位数 [四分位数间距]：14 [10-19] 对 4 [2-7]，P<0.001）。两组间 3 个月良好结果的频率没有显着差异（EVT：64.0% 与 IVT：86.8%；OR 调整后 0.56 [0.24-1.32]）。与 IVT 相比，EVT 与更高的再通率相关（80.5% 对 40.7%；OR 调整后为 8.85 [4.28-18.29]）。所有二次分析均显示 EVT 组的再通率更高，然而，与 IVT 组相比，这从未转化为更好的功能结果率。结论 尽管 EVT 的完全再通率更高，但在 AIS 和 LVO 的 CeAD 患者的功能结果方面，我们没有观察到 EVT 优于 IVT 的信号。病理生理学 CeAD 特征或他们的年轻年龄是否可以解释这一观察值得进一步研究。