Abstract
Objectives
Ischemic stroke is a leading cause of death and disability worldwide. For patients
with large vessel occlusion stroke, endovascular treatment is now the most effective
treatment. We aimed to assess the outcome of patients undergoing endovascular treatment
for large vessel occlusion stroke in a real-world setting, comparing our results with
data from randomized clinical trials, and recognizing the factors associated with
prognosis.
Materials and methods
We retrospectively collected data on endovascular procedures performed in one comprehensive
stroke center in consecutive patients presenting with large vessel occlusion stroke
from January 2017 to January 2020. Data on baseline clinical, imaging, and treatment-related
characteristics were recorded. Selection of patients and treatment approach was not
standardized but followed current guidelines for ischemic stroke. Functional outcome
was evaluated 3 months after endovascular treatment. Clinical, imaging and treatment-related
variables associated to outcome were evaluated with univariate and multivariable analyses.
Results
Four hundred twelve patients were included in our study. Three-month functional independence
was achieved in 50.5% of patients (50.3% in the anterior stroke and 52.1% in the posterior
stroke subgroup). Successful arterial reperfusion was observed in 84.3% of patients.
Age (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.20–0.87, p = 0.020]), severe stroke at onset (OR 0.40, 95%CI 0.19–0.83), procedure related complications
(OR 0.45, 95%CI 0.20–0.99), and good collateral circulation (OR 2.69, 95%CI 1.17–6.16)
were associated with 3-month functional independence in multivariable model.
Conclusions
Our real-world outcome results are in line with data from large randomized clinical
trials on endovascular treatment for large vessel occlusion stroke.
Key Words
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References
- Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis.BMJ. 2016; (Published Online First)https://doi.org/10.1136/bmj.i1754
- Mechanical thrombectomy-ready comprehensive stroke center requirements and endovascular stroke systems of care: recommendations from the endovascular stroke standards committee of the society of vascular and interventional neurology (SVIN).Interv Neurol. 2015; 4: 138-150https://doi.org/10.1159/000442715
- Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study.BMC Neurol. 2020; 20: 81https://doi.org/10.1186/s12883-020-01653-z
- Clinical and procedural predictors of outcomes from the endovascular treatment of posterior circulation strokes.Stroke. 2016; 47: 782-788https://doi.org/10.1161/STROKEAHA.115.011598
- Endovascular treatment of acute stroke: a call for individualized patient selection.Stroke. 2019; 50: 2612-2618https://doi.org/10.1161/STROKEAHA.119.023811
- Transfer to the local stroke center versus direct transfer to endovascular center of acute stroke patients with suspected large vessel occlusion in the Catalan territory (RACECAT): study protocol of a cluster randomized within a cohort trial.Int J Stroke. 2019; 14: 734-744https://doi.org/10.1177/1747493019852176
- Endovascular treatment of acute ischemic stroke.Contin Lifelong Learn Neurol. 2020; 26: 310-331https://doi.org/10.1212/CON.0000000000000852
- Impact of the SARS-COV-2 pandemic on the endovascular treatment of acute stroke – an Italian single-center experience.J Stroke Cerebrovasc Dis. 2021; 30https://doi.org/10.1016/J.JSTROKECEREBROVASDIS.2021.106028
- SPREAD (Stroke Prevention and Educational Awareness Diffusion). Italian Guidelines For Stroke Prevention And Management.8th ed. ISO, 2017
- Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial.Lancet. 2019; (Published Online First)https://doi.org/10.1016/S0140-6736(19)30297-1
- Evolution of the modified Rankin Scale and its use in future stroke trials.Stroke. 2017; https://doi.org/10.1161/STROKEAHA.117.017866
- Multiphase CT angiography: a new tool for the imaging triage of patients with acute ischemic stroke.Radiology. 2015; 275: 510-520https://doi.org/10.1148/radiol.15142256
- Impact of modified TICI 3 versus modified TICI 2b reperfusion score to predict good outcome following endovascular therapy.Am J Neuroradiol. 2017; (Published Online First)https://doi.org/10.3174/ajnr.A4968
- Multisociety consensus quality improvement revised consensus statement for endovascular therapy of acute ischemic stroke.Int J Stroke. 2018; (Published Online First)https://doi.org/10.1177/1747493018778713
- Thrombectomy for distal, medium vessel occlusions.Stroke. 2020; (Published Online First)https://doi.org/10.1161/strokeaha.120.028956
- Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data.Lancet Neurol. 2018; 17: 895-904https://doi.org/10.1016/S1474-4422(18)30242-4
- Positive impact of the participation in the ENCHANTED trial in reducing door-to-needle time.Sci Rep. 2017; 7: 1-6https://doi.org/10.1038/s41598-017-14164-8
- Endovascular therapy for acute ischaemic stroke: the pragmatic ischaemic stroke thrombectomy evaluation (PISTE) randomised, controlled trial.J Neurol Neurosurg Psychiatry. 2017; 88: 38-44https://doi.org/10.1136/jnnp-2016-314117
- Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial.Lancet Neurol. 2016; 15: 1138-1147https://doi.org/10.1016/S1474-4422(16)30177-6
- Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke.N Engl J Med. 2015; 372: 2285-2295https://doi.org/10.1056/NEJMoa1415061
- Age and outcome after endovascular treatment in anterior circulation large-vessel occlusion stroke: ETIS registry results.Cerebrovasc Dis. 2021; 50: 68-77https://doi.org/10.1159/000512203
- Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial.Lancet Neurol. 2020; 19: 115-122https://doi.org/10.1016/S1474-4422(19)30395-3
- Equivalent favorable outcomes possible after thrombectomy for posterior circulation large vessel occlusion compared with the anterior circulation: The MUSC experience.J Neurointerv Surg. 2018; (Published Online First)https://doi.org/10.1136/neurintsurg-2017-013420
- Current endovascular strategies for posterior circulation large vessel occlusion stroke: report of the society of neurointerventional surgery standards and guidelines committee.J Neurointerv Surg. 2019; (Published Online First)https://doi.org/10.1136/neurintsurg-2019-014873
- Best evidence on mechanical thrombectomy for patients with vertebrobasilar occlusion.Lancet Neurol. 2020; https://doi.org/10.1016/S1474-4422(19)30477-6
- Endovascular treatment of very elderly patients aged ≥90 with acute ischemic stroke.J Am Heart Assoc. 2020; 9e014447https://doi.org/10.1161/JAHA.119.014447
- Collaterals in ischemic stroke.Brain Hemorrhages. 2020; 1: 6-12https://doi.org/10.1016/j.hest.2019.12.003
- Complications of endovascular treatment for acute ischemic stroke: prevention and management.Int J Stroke. 2018; https://doi.org/10.1177/1747493017743051
- Optimal transfer paradigm for emergent large vessel occlusion strokes: recognition to recanalization in the RACECAT trial.J Neurointerv Surg. 2021; 13: 97-99https://doi.org/10.1136/neurintsurg-2020-017227
- Endovascular thrombectomy with or without intravenous alteplase in acute stroke.N Engl J Med. 2020; (Published Online First)https://doi.org/10.1056/NEJMoa2001123
- Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial.JAMA. 2021; 325: 234-243https://doi.org/10.1001/JAMA.2020.23523
- Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: ameta-analysis.JAMA J Am Med Assoc. 2016; (Published Online First)https://doi.org/10.1001/jama.2016.13647
- From “Time is Brain” to “Imaging is Brain”: a paradigm shift in the management of acute ischemic stroke.J Neuroimaging. 2020; 30: 562-571https://doi.org/10.1111/jon.12693
- European stroke organisation (ESO) - European society for minimally invasive neurological therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke.J Neurointerv Surg. 2019; 0: 1-30https://doi.org/10.1136/NEURINTSURG-2018-014569
- Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity.BMC Neurol. 2019; 19: 1-9https://doi.org/10.1186/S12883-019-1237-2/TABLES/2
Article info
Publication history
Published online: April 25, 2022
Accepted:
April 8,
2022
Received in revised form:
April 4,
2022
Received:
November 29,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106511
Copyright
© 2022 Elsevier Inc. All rights reserved.
