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Updated: Nov 17, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China: A Real-World Nationwide Registry
Baixue Jia1, Zeguang Ren2, Maxim Mokin2
1Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University.
Insights
Endovascular treatment (EVT) for acute ischemic stroke in China shows favorable outcomes, with 45% achieving functional independence. Key predictors include younger age, faster treatment times, and local anesthesia, confirming EVT
Area of Science:
- Neurology
- Interventional Cardiology
- Public Health
Background:
- Endovascular treatment (EVT) offers a potential benefit for acute ischemic stroke caused by large vessel occlusion (LVO).
- The efficacy of EVT in clinical practice within developing countries, specifically China, requires validation.
- Randomized trial findings for EVT in LVO need to be assessed for generalizability to diverse patient populations.
Purpose of the Study:
- To evaluate the effectiveness of EVT for acute ischemic stroke in a large Chinese patient cohort.
- To determine if the benefits observed in randomized trials can be replicated in real-world clinical practice in China.
- To identify factors influencing functional outcomes after EVT for LVO in the Chinese population.
Main Methods:
- A prospective registry study was conducted across 111 centers in China.
- Included patients had acute ischemic stroke with imaging-confirmed intracranial LVO undergoing EVT.
- The primary outcome was functional independence at 90 days (modified Rankin Scale score 0-2).
Main Results:
- 1793 patients were enrolled; 77.9% had anterior circulation LVO and 22.1% had posterior circulation LVO.
- Functional independence at 90 days was achieved by 45% (anterior) and 44% (posterior) circulation groups.
- Predictors of independence included younger age, longer onset-to-puncture time, local anesthesia, successful reperfusion (mTICI 2b/3), and lower NIHSS at 24 hours.
Conclusions:
- Favorable outcomes with EVT for acute ischemic stroke are achievable in Chinese clinical practice, despite population-specific characteristics.
- EVT is a viable treatment option for LVO in China, supporting its broader implementation.
- Further research can refine patient selection and treatment protocols to optimize EVT outcomes in China.
Background And Purpose:
The benefit of endovascular treatment (EVT) for large vessel occlusion in clinical practice in developing countries like China needs to be confirmed. The aim of the study was to determine whether the benefit of EVT for acute ischemic stroke in randomized trials could be generalized to clinical practice in Chinese population.
Methods:
We conducted a prospective registry of EVT at 111 centers in China. Patients with acute ischemic stroke caused by imaging-confirmed intracranial large vessel occlusion and receiving EVT were included. The primary outcome was functional independence at 90 days defined as a modified Rankin Scale score of 0 to 2. Outcomes of specific subgroups in the anterior circulation were reported and logistic regression was performed to predict the primary outcome.
Results:
Among the 1793 enrolled patients, 1396 (77.9%) had anterior circulation large vessel occlusion (median age, 66 [56-73] years) and 397 (22.1%) had posterior circulation large vessel occlusion (median age, 64 [55-72] years). Functional independence at 90 days was reached in 45% and 44% in anterior and posterior circulation groups, respectively. For anterior circulation population, underlying intracranial atherosclerotic disease was identified in 29% of patients, with higher functional independence at 90 days (52% versus 44%; P=0.0122) than patients without intracranial atherosclerotic disease. In the anterior circulation population, after adjusting for baseline characteristics, procedure details, and early outcomes, the independent predictors for functional independence at 90 days were age <66 years (odds ratio [OR], 1.733 [95% CI, 1.213-2.476]), time from onset to puncture >6 hours (OR, 1.536 [95% CI, 1.065-2.216]), local anesthesia (OR, 2.194 [95% CI, 1.325-3.633]), final modified Thrombolysis in Cerebral Infarction 2b/3 (OR, 2.052 [95% CI, 1.085-3.878]), puncture-to-reperfusion time ≤1.5 hours (OR, 1.628 [95% CI, 1.098-2.413]), and National Institutes of Health Stroke Scale score 24 hours after the procedure <11 (OR, 9.126 [95% CI, 6.222-13.385]).
Conclusions:
Despite distinct characteristics in the Chinese population, favorable outcome of EVT can be achieved in clinical practice in China. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.
