Efficacy And Safety Of Endovascular Treatment For Acute Ischemic Stroke

Background: Endovascular treatment has been proved to be an effective recanalization method for large vessel occlusion in acute ischemic stroke by a number of clinical randomized trials.In the real world,there is still a lack of comprehensive data analysis and comparison of adequate cases in China,and the overall short-term and long-term prognosis of patients after surgery remains unclear.What factors affect whether favorable outcomes are achieved following endovascular treatment for acute ischemic stroke has not been established.Moreover,in clinical practice,not every stroke center is capable of accurately evaluating the clinical and imaging mismatches strictly based on multimodal imaging examination and screening in suitable intravascular treatment cases.Objective: To further explore the efficacy and safety of endovascular treatment in Chinese patients with acute ischemic stroke in real world setting and analyze the related factors that affected a good prognosis in acute ischemic stroke.So as to provide more real-world data to support intravascular recanalization therapy in acute ischemic stroke,and our results are significant for guiding future clinical work.Methods: This is a multi-center,prospective and observational registration study.The subjects were from neurology,neurosurgery or senior stroke centers of six hospitals in Guangdong Province,China.A total of 237 patients with acute ischemic stroke who received intravascular recanalization from March 2017 to May 2018 were recruited.The main efficacy outcome of our study was a modified Ranking Scale(m RS)scores of 0-2 at 90 days after surgery,secondary outcomes were favorable reperfusion of modified Thrombolysis in Cerebral Infarction(m TICI)of 2b/3 grade after surgery,National Institutes of Health Stroke Scale(NIHSS)score at 24 hours,7 days after intervention and at discharge,recurrence stroke at 90 days.The safety outcomes included asymptomatic intracranial hemorrhage,symptomatic intracranial hemorrhage during hospitalization and mortality at 90 days after stroke.m RS 0-2 indicated functional independence.Intracranial hemorrhage was defined according to Heidelberg bleeding classification.Multivariate logistic regression analysis was used to investigate the related factors of m RS 0-2 score in patients with good prognosis 90 days after operation.Results: The median age of patients was 67 years(range 26 to 92),42.7% patients achieved functional independence at 90 days(m RS 0-2),13.7% patients found SICH,the mortality within 90 days was 26.2%.In multivariate analysis,age>80years[odds ratio,OR(95%confidence interval[CI])5.11(1.40-16.67),P=0.014],NIHSS at 24 hours after intervention?8 [OR(95%CI)4.82(1.70-13.72),P=0.004] and SICH[OR(95%CI)10.21(1.08-97.00),P=0.043] performed differences,which were independent risk factors of patients functional outcomes.While m TICI2b/3[OR(95%CI)0.12(0.02-0.64),P=0.014] was in significance,showing that successful reperfusion was related with good outcomes at 90 days.Conclusions: 1.In the real world,mechanical thrombectomy-based endovascular treatment can achieve good efficacy outcomes for patients with acute ischemic stroke.2.In the real world,the incidence of SICH treated by mechanical thrombectomy is higher than that of randomized clinical trials,but patients in general benefit.3.Independent risk factors related to a good prognosis in patients receiving endovascular therapy may include age,SICH during hospital stay and severe neurological deficits at 24 hours after surgery.Possible protective factors include good recanalization of the main responsible vessels after surgery,which lead to successful reperfusion of the corresponding brain tissue.