Endovascular Stroke Treatment: How Far Downstream Should We Go?

Area of Science:

• Neurology
• Interventional Radiology
• Vascular Medicine

Background:

• Endovascular thrombectomy is standard for large vessel occlusion.
• Previous studies linked good outcomes to clot location (distance to thrombus) after thrombolysis.
• This study compares outcomes based on distance to thrombus for endovascular vs. intravenous treatments.

Purpose of the Study:

• To analyze the relationship between distance to thrombus and good outcomes in stroke patients treated with endovascular therapy versus intravenous thrombolysis.
• To determine if occlusion site impacts treatment efficacy differently between endovascular and intravenous approaches.

Main Methods:

• Dual-center analysis of stroke patients with middle cerebral artery occlusion.
• Inclusion criteria: completed treatment, full clinical course documentation.
• Distance to thrombus (DT) measured from pre-treatment images; correlated with 90-day modified Rankin Scale (mRS) scores, stratified by treatment.

Main Results:

• 280 patients included; a correlation between good outcome and DT was observed after IV thrombolysis.
• No correlation between good outcome and DT was found after endovascular treatment (p=0.227).
• For DT > 26 mm, IV thrombolysis showed better outcomes than endovascular treatment.

Conclusions:

• For middle cerebral artery occlusions, endovascular treatment outcomes are independent of occlusion site (DT).
• Intravenous thrombolysis outcomes are dependent on occlusion site (DT).
• IV thrombolysis alone was superior to endovascular treatment for peripheral M2 occlusions (DT > 26 mm).