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Updated: Dec 12, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Outcomes following endovascular therapy for acute stroke by interventional cardiologists
Tamunoinemi Bob-Manuel1,2, Marius Hornung3, Steven Guidera4
1Department of Cardiology, Ochsner Clinical School, University of Queensland, St Lucia, Australia.
Insights
Interventional cardiologists can effectively perform endovascular therapy for acute ischemic stroke. This study shows comparable outcomes to neuro-interventionalists, supporting trials in underserved areas.
Area of Science:
- Neurology
- Cardiology
- Interventional Radiology
Background:
- Geographic disparities exist in access to neuro-interventionalists for large vessel occlusion (LVO) acute ischemic stroke (AIS).
- Interventional cardiologists (IC) possess skills applicable to endovascular therapy (EVT) for AIS.
Purpose of the Study:
- To evaluate the outcomes of AIS intervention performed by IC within a stroke team.
- To assess the feasibility of IC performing EVT for LVO AIS in centers lacking dedicated neuro-interventionalists (NI).
Main Methods:
- Retrospective analysis of 166 consecutive patients undergoing EVT for LVO AIS by IC between 2009-2019.
- Primary outcome: modified Rankin score (mRs) ≤ 2 at 90 days.
- Logistic regression (univariate and multivariate) used to identify predictors of mortality and poor outcome (mRs > 2).
Main Results:
- 30-day all-cause mortality was 22%.
- Favorable 90-day outcome (mRs ≤ 2) was achieved in 49% of patients.
- Higher baseline NIH Stroke Scale score predicted increased 30-day mortality and unfavorable 90-day outcomes.
Conclusions:
- EVT for AIS performed by IC demonstrates outcomes comparable to those reported for NI physicians in major trials.
- This supports further clinical trials investigating IC-led EVT for AIS in areas with limited access to NI.
- Multidisciplinary stroke teams including IC can improve access to timely AIS treatment.
Objectives:
To summarize the outcomes of acute ischemic stroke (AIS) intervention by interventional cardiologists (IC) working on a stroke team.
Background:
There is a geographic maldistribution of dedicated neuro-interventionalists (NI) to treat large vessel occlusion (LVO) AIS.
Methods:
Results of 166 consecutive patients who received endovascular therapy (EVT) for AIS due to LVO by IC at three centers between 2009 and 2019 are reported. A modified Rankin score (mRs) of ≤ 2 at 90 days after EVT was used as the primary measurement of a good neurological outcome. Univariate logistic regression was used to evaluate predictors of the mRS > 2 and mortality. Those variables with significance of p < .2 from the univariate analysis were included in a multivariate analysis.
Results:
All-cause mortality at 30 days was 22%. A favorable clinical outcome, mRS ≤ 2 at 90 days, was 49%. After multivariate analysis and controlling for confounders, a higher baseline NIHSS was predictive of 30-day mortality (OR 1.20 [95% CI 1.09-1.32] p < .001) and unfavorable clinical outcome (mRS > 2) at 90 days (OR 1.16 [95% CI 1.07-1.25] p < .001).
Conclusion:
Outcomes for carotid stent capable IC performing EVT for AIS are comparable to those achieved by NI physicians in major randomized clinical trials. Our data supports conducting a clinical trial of carotid stent capable IC working on multidisciplinary stroke teams to perform EVT for AIS due to LVO in communities and hospitals without timely access (<60 min by ground transport) to dedicated NI.
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