Mechanical Thrombectomy in Acute Ischemic Stroke: Initial Single-Center Experience and Comparison with Randomized...

Area of Science:

• Neurology
• Interventional Cardiology
• Vascular Surgery

Background:

• Intravenous thrombolysis has limitations for large-vessel occlusions in acute ischemic stroke.
• Mechanical thrombectomy has emerged as a superior reperfusion therapy for anterior circulation large-vessel occlusion.
• Real-world effectiveness of mechanical thrombectomy needs validation beyond randomized controlled trials.

Purpose of the Study:

• To evaluate the efficacy and safety of mechanical thrombectomy in a real-world setting.
• To compare outcomes of mechanical thrombectomy in a tertiary hospital with landmark randomized trials.
• To assess the feasibility of achieving similar results to clinical trials in routine practice.

Main Methods:

• Analysis of a prospective observational registry of 77 patients undergoing mechanical thrombectomy.
• Comparison of patient characteristics and outcomes with data from MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT trials.
• Utilization of a simplified imaging protocol (non-enhanced CT and CT angiography) for rapid patient selection.

Main Results:

• Patient demographics and baseline characteristics were comparable to those in randomized trials.
• Functional independence at 90 days was achieved in approximately two-thirds of patients.
• High rates of successful recanalization (87%) and low rates of symptomatic intracranial hemorrhage (2.6%) were observed.

Conclusions:

• Mechanical thrombectomy is a safe and effective treatment for acute ischemic stroke in a real-world setting.
• Outcomes in a real-world scenario are comparable to those reported in major randomized controlled trials.
• Simplified imaging protocols facilitate fast recanalization and support the widespread adoption of mechanical thrombectomy.