Related Experiment Video
Updated: May 16, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
A controlled trial of revascularization in acute stroke
Martin Roubec1, Martin Kuliha, Václav Procházka
1Comprehensive Stroke Center, Department of Neurology, Faculty of Medicine, Ostrava University and University Hospital Ostrava, 17 Listopadu 1790, CZ-708 52 Ostrava-Poruba, Czech Republic.
Insights
Intraarterial revascularization with stents improved outcomes for acute ischemic stroke patients with middle cerebral artery occlusion when intravenous thrombolysis failed or was contraindicated. This effective treatment option demonstrated significant clinical benefit.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Acute ischemic stroke (AIS) due to middle cerebral artery (MCA) occlusion requires timely recanalization.
- Intravenous thrombolysis (IVT) is a standard treatment but has limitations, including contraindications and treatment failure.
- Endovascular treatment, including intraarterial revascularization with stents, offers an alternative for select patients.
Purpose of the Study:
- To compare the safety and effectiveness of intraarterial revascularization with stents versus no revascularization in AIS patients.
- To evaluate outcomes in patients who failed to respond to IVT or had contraindications to IVT.
- To assess the impact of MCA recanalization on clinical outcomes.
Main Methods:
- A case-control study involving 131 patients with acute MCA occlusion.
- Patients were categorized based on IVT response and contraindications, receiving either endovascular treatment or no further therapy.
- Outcomes assessed included neurologic deficit, MCA recanalization rates, symptomatic intracerebral hemorrhage (SICH), and 3-month modified Rankin Scale (mRS) scores.
Main Results:
- Intraarterial revascularization achieved high MCA recanalization rates (92.6%).
- Significantly more patients in the endovascular treatment groups (2A and 3A) achieved a favorable 3-month outcome (mRS 0-2) compared to those receiving no further therapy (2B and 3B).
- Favorable outcomes were significantly associated with successful MCA recanalization (OR, 5.55; P = .006).
Conclusions:
- Intraarterial revascularization with stents is a safe and effective treatment for acute MCA occlusion in patients with IVT failure or contraindications.
- Successful MCA recanalization is a key predictor of favorable clinical outcomes.
- Endovascular treatment offers a valuable therapeutic option to improve functional recovery in this patient population.
Purpose:
To compare safety and utility of intraarterial revascularization with use of stents to no revascularization in patients who either failed to respond to intravenous thrombolysis (IVT) or have contraindications to IVT.
Materials And Methods:
The case-control study was approved by local ethics committees; all patients signed informed consent. One hundred thirty-one patients (74 men; mean age, 65.9 years ± 12.3; range, 25-86 years) with acute ischemic stroke (AIS) due to middle cerebral artery (MCA) occlusion were enrolled; 75 underwent IVT. No further recanalization therapy was performed in 26 (35%) IVT-treated patients with MCA recanalization (group 1). Patients with IVT failure after 60 minutes were allocated to endovascular treatment (group 2A) or no further therapy (group 2B). Patients with contraindication to IVT were allocated to endovascular treatment within 8 hours since AIS onset (group 3A) or to no recanalization therapy (group 3B). Neurologic deficit at admission, MCA recanalization, symptomatic intracerebral hemorrhage (SICH), and 3-month clinical outcome were evaluated. Favorable clinical outcome was defined as modified Rankin scale score 0-2 at 3 months after stroke onset. Two-sided Mann-Whitney U test, independent samples t test, Fisher exact test, multivariate logistic regression analysis of baseline variables, and complete MCA recanalization for the prediction of favorable clinical outcome were used for statistical evaluation.
Results:
Median National Institutes of Health Stroke Scale score at admission was 13.5, 16.0, 15.5, 15.0, and 16.0 in groups 1, 2A, 2B, 3A, and 3B, respectively (P > .05); SICH occurred in one of 26 (3.8%), one of 23 (4.3%), one of 26 (3.8%), one of 31 (3.2%), and one of 25 (4.0%) patients, respectively (P > .05). MCA recanalization after endovascular treatment was achieved in 50 of 54 (92.6%) patients. Favorable outcome was significantly different between groups 2A and 2B (10 of 23 [43.5%] and four of 26 [15.4%], respectively; P = .03) and groups 3A and 3B (14 of 31 [45.2%] and two of 25 [8.0%], respectively; P = .004) and was dependent on MCA recanalization (odds ratio, 5.55; P = .006).
Conclusion:
In this controlled trial, intraarterial revascularization with stents was an effective and safe-effective treatment option in patients with acute MCA occlusion with contraindication to IVT or after IVT failure.
