Primary Endovascular Treatment of Acute Ischemic Stroke Using Stent Retrievers: Initial Egyptian Experience

Several mechanical thrombectomy (MT) devices have been designed with the goal of improving the recanalization rates of major intracranial artery occlusions.

In this single-center experience, we analyzed the acute ischemic stroke (AIS) treatment with Primary MT; safety and efficacy and clinical results in our patients with large vessel occlusion (LVO).

During a five-year period (from September 2011 to July 2016), out of 996 patients who presented to our center with a diagnosis of AIS, 113 (11.4%) patients (55 men and 58 women) underwent primary mechanical recanalization within three hours from onset of signs and symptoms for anterior and 12 hours for posterior circulation (with computer tomography angiography/perfusion ELVO). Successful recanalization (thrombolysis in cerebral infarction 2b-3), good outcome (modified Rankin scale score 0-2) and overall mortality rate, and symptomatic intracranial hemorrhage [sICH: parenchymal hematoma Type 1 or Type 2; National Institutes of Health Stroke Scale (NIHSS) score increment ≥4 points] were prospectively assessed.

The mean age of the patients was 62 ± 11.73 years, with a baseline mean admission NIHSS score of 16.7 ± 3.2. The mean time from onset to puncture (time to treatment) was 208.55 ± 53.49. Successful recanalization was achieved in 104 (92%) cases. Good outcome was observed in 89 (78.8%) patients, and mortality was 11.5% (n = 13). sICH occurred in five (4.4%) patients.

MT, within the first 4.5 hours, as primary treatment of acute LVO stroke provides high rate of recanalization and favorable clinical outcomes with low procedural complications.