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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

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Outcome after endovascular treatment for acute ischemic stroke by underlying etiology: Tertiary experience and

Chunlin Ma1,2, Wenbo Cao1,3, Yang Huang1,4

  • 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Frontiers in Neurology
|May 1, 2023
PubMed

Insights

Outcomes for acute ischemic stroke patients with large vessel occlusion treated with endovascular thrombectomy were similar regardless of etiology. Intracranial atherosclerotic stenosis (ICAS) and cardioembolism (CE) showed comparable functional outcomes and mortality rates.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Surgery

Background:

  • Large vessel occlusion (LVO) is a critical cause of acute ischemic stroke (AIS).
  • Endovascular thrombectomy (EVT) is a primary treatment for AIS-LVO.
  • Distinguishing between intracranial atherosclerotic stenosis (ICAS) and cardioembolism (CE) as etiologies is crucial for understanding stroke mechanisms and outcomes.

Purpose of the Study:

  • To compare the clinical outcomes of AIS patients with LVO treated with EVT, focusing on the two major etiologies: ICAS and CE.
  • To evaluate the impact of ICAS versus CE on functional outcomes, mortality, and hemorrhage rates post-EVT.

Main Methods:

  • Retrospective analysis of 302 anterior circulation AIS patients undergoing EVT.
  • Collection of clinical and laboratory data, comparing outcomes like favorable outcome (modified Rankin Scale 0-2), mortality, intracranial hemorrhage (ICH), and symptomatic ICH (sICH).
  • Inclusion of a systematic review and meta-analysis of 8 studies (552 ICAS patients, 1,402 CE patients).

Main Results:

  • The ICAS group (86 patients) was younger and had higher rates of smoking and drinking history, and required more rescue therapy compared to the CE group (216 patients).
  • No significant differences in favorable outcome or mortality were observed between ICAS and CE groups in the retrospective analysis.
  • Meta-analysis indicated slightly higher favorable outcomes (54.2% vs. 46.3%) and lower mortality (14.3% vs. 22.2%) and ICH rates (19.5% vs. 31.9%) in the ICAS group compared to the CE group, though sICH rates were similar.

Conclusions:

  • Etiology (ICAS vs. CE) did not significantly impact functional outcomes in AIS-LVO patients treated with EVT.
  • Despite differences in baseline characteristics, EVT outcomes are comparable between ICAS and CE etiologies.
  • The study supports that ICAS is not associated with significantly different outcomes compared to CE in anterior circulation AIS-LVO patients undergoing EVT.
Abstract

Keywords:
acute ischemic strokecardioembolismdifferent etiologyendovascular treatmentintracranial atherosclerosismechanical thrombectomy

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