Intraarterial multi-modal reperfusion therapy for acute ischemic stroke: a10 year single-center experience

Only 0.5% of stroke patients in Israel are treated with endovascular multi-modal reperfusion therapy (MMRT) each year.

To assess our experience with MMRT over the last decade.

We analyzed data from our stroke registry of patients undergoing MMRT during 2002-2011. All patients underwent multi-parametric imaging studies including subtraction angiography according to a predetermined algorithm. Stroke severity was measured with the National Institutes of Health Stroke Scale (NIHSS). Disability was measured with the modified Ranking Scale (mRS) and classified as favorable (mRS < or = 2) or unfavorable. Target vessel recanalization was determined with the thrombolysis in myocardial infarction (TIMI) scale.

During the study period 204 patients were treated; 166 of them had complete data sets including mRS scores at 90 days and were included in the analysis. Favorable outcomes at 90 days post-stroke were observed in 37% of patients and the mortality rate was 25%. Patients with favorable outcomes were younger, had significantly lower NIHSS scores on admission and discharge, and more often had complete target vessel recanalization (TIMI 3). On regression analysis the only factor associated with favorable outcome was TIMI 3, whereas increasing age and NIHSS scores on admission and discharge were predictors of poor outcome.

Our data show that MMRT can be successfully implemented in patients with severe stroke in Israel. More than a third of our patients with severe ischemic strokes who could not receive acute treatment were functionally independent after MMRT, demonstrating that this procedure is an important alternative for patients who are not candidates for intravenous tissue plasminogen activator (tPA) or do not achieve recanalization with tPA.