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Updated: Mar 26, 2026
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
12.7K
Neurothrombectomy in acute ischaemic stroke: a prospective single-centre study and comparison with randomized
O Nikoubashman1, M Jungbluth2, K Schürmann2
1Department of Neuroradiology, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany.
European Journal of Neurology
|February 7, 2016
Summary
Mechanical thrombectomy significantly improves outcomes for acute ischemic stroke patients with large vessel occlusion. This study shows real-world application of intra-arterial therapy can safely treat more patients.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Recent multicentre randomized controlled trials (RCTs) demonstrate mechanical thrombectomy's superiority over systemic thrombolysis for large vessel occlusion acute ischemic stroke.
- Despite proven efficacy, only a small fraction of screened patients (approx. 1%) are eligible for intra-arterial (IA) therapy due to strict inclusion criteria.
Purpose of the Study:
- To evaluate the real-world application and effectiveness of IA therapy in a broader patient population within a specialized stroke center.
- To determine if pragmatic inclusion criteria can increase the percentage of eligible patients for advanced stroke treatment.
Main Methods:
- A prospective, single-centre analysis of 3123 consecutive acute ischemic stroke patients (February 2010 - December 2014).
- Inclusion criteria focused on sparse early ischemic signs (ASPECT score ≥7), anterior circulation large vessel occlusion, and treatment within 6 hours of symptom onset.
- Interdisciplinary treatment decisions guided the administration of IA therapy (primarily stent-assisted thrombectomy with IV recombinant tissue plasminogen activator) or standard IV thrombolysis.
Main Results:
- 154 patients (4.9%) met the pragmatic inclusion criteria.
- 130 patients (4.2%) received IA treatment, and 24 patients (0.7%) received standard IV thrombolysis.
- The IA treatment group showed a significant improvement in disability (modified Rankin Scale, P=0.05) and nearly double the rate of good functional outcomes (41.2% vs. 21.2%) compared to the IV group at 3-month follow-up.
Conclusions:
- Applying state-of-the-art IA therapy with pragmatic inclusion criteria in a specialized tertiary stroke center is feasible and safe under real-world conditions.
- This approach successfully treats a higher percentage of acute ischemic stroke patients compared to traditional eligibility thresholds, achieving comparable success rates to published RCTs.
