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Safety of Endovascular Therapy in Progressive Ischemic Stroke and Anterior Circulation Large Artery Occlusion. | LitMetric

AI Article Synopsis

  • - This study focuses on the safety of endovascular therapy (ET) for patients with progressive ischemic stroke (PIS) caused by large artery occlusion, specifically selecting individuals based on the presence of ischemic penumbra in brain imaging.
  • - A total of 148 patients underwent ET, with 100 treated within 6 hours (early) and 48 after 6 hours (late); results showed higher successful recanalization and lower mortality rates in the late group compared to the early group.
  • - The findings suggest ET can be safely performed in selected PIS patients, but further randomized clinical trials are needed to better understand its effectiveness.

Article Abstract

Background And Objective: The prognosis of progressive ischemic stroke (PIS) caused by large proximal artery occlusion with hemodynamic was poor. Our study aimed to investigate the safety of endovascular therapy (ET) for patients with PIS who were selected based on ischemic penumbra detected on brain imaging.

Methods: A cohort of consecutive patients with PIS, who were treated with ET, were identified. Patients were selected for ET based on the presence of ischemic penumbra using magnetic resonance imaging. Clinical outcome includes 90-day modified Rankin scale, mortality, and symptomatic intracerebral hemorrhage (sICH) rate. Multivariate analysis was performed to compare treatment time of ≤6 hours (early) with >6 hours (late) after stroke.

Results: One hundred forty-eight patients were treated (100 early and 48 late). Compared with the early group, more successful recanalization rate in the late group (100% vs. 89%, P = 0.017), lower mortality (2.1% vs. 12%, P = 0.046), better clinical outcome (modified Rankin scale score ≤2, 81.3% vs. 65%, P = 0.046), and sICH rate was similar between the 2 groups (7.0% vs. 9.5%, P = 1.00). Only pretreatment National Institutes of Health Stroke Scale score (odds ratio [OR] = 0.836, P = 0.025), successful recanalization (OR = 7.077, P = 0.038), collateral status (OR = 3.121, P = 0.016), and sICH (OR = 0.053, P = 0.013) were predictors of a good prognosis.

Conclusions: In appropriately selected patients with PIS, ET can be performed safely. Furthermore, randomized clinical trials are needed to assess its effectiveness.

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Source
http://dx.doi.org/10.1016/j.wneu.2018.10.059DOI Listing

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