Stent Retriever Thrombectomy in Patients Who Are Ineligible for Intravenous Thrombolysis: A Multicenter Retrospective...

Area of Science:

• Neurology
• Interventional Neuroradiology
• Emergency Medicine

Background:

• Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is standard for acute ischemic stroke within 4.5 hours.
• Many patients are ineligible for IV thrombolysis due to contraindications.
• Mechanical thrombectomy shows superiority for large-vessel occlusions when combined with IV rtPA.

Purpose of the Study:

• To evaluate the efficacy of mechanical thrombectomy in acute ischemic stroke patients ineligible for IV thrombolysis.
• To assess outcomes in patients with large-artery occlusions treated with mechanical thrombectomy within 4.5 hours.

Main Methods:

• Retrospective analysis of 130 mechanical thrombectomy procedures from January 2010 to October 2014.
• Inclusion criteria: acute stroke, large-artery occlusion, IV thrombolysis ineligibility, and symptom onset to treatment time ≤4.5 hours.
• Evaluation of recanalization success (TICI 2b/3), clinical outcomes (mRS 0-2), complications, and hemorrhages.

Main Results:

• Successful recanalization (TICI 2b/3) achieved in 77.7% of patients.
• Good clinical outcome (mRS 0-2) in 37.9% of patients, significantly correlated with successful recanalization (P=.048).
• Early recanalization (within 4.5 hours) led to better outcomes (50% vs 20%, P=.001). Symptomatic hemorrhage in 13.1%, mortality 24.2%.

Conclusions:

• Mechanical thrombectomy is effective for acute large-artery occlusion in patients ineligible for IV thrombolysis.
• Early recanalization is crucial for achieving favorable clinical outcomes.
• This endovascular approach provides a viable treatment option for a select group of stroke patients.