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Updated: May 12, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular Treatment of Acute Large Vessel Occlusion in the Anterior and Posterior Circulation
Yong-Feng Han1, Qian Zhao2, Dong-Liang Zhang1
1Department of Neurosurgery, Shijiazhuang People's Hospital, Shijiazhuang, China.
Insights
Endovascular treatment (EVT) is effective for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Factors like younger age and faster recanalization improve outcomes, while posterior circulation strokes have worse results.
Area of Science:
- Neurology
- Interventional Cardiology
- Stroke Medicine
Background:
- Endovascular treatment (EVT) is a recommended first-line therapy for acute ischemic stroke (AIS) due to large vessel occlusion (LVO).
- Evaluating EVT's efficacy and safety in both anterior and posterior circulations is crucial for optimizing patient care.
Purpose of the Study:
- To assess the efficacy, safety, and predictors of favorable outcomes for EVT in patients with AIS caused by LVO.
- To compare outcomes between anterior circulation occlusion (ACO) and posterior circulation occlusion (PCO) patients.
Main Methods:
- Retrospective analysis of consecutive patients undergoing EVT for LVO-caused AIS.
- Data collected included clinical characteristics, symptomatic intracranial hemorrhage (sICH), modified Rankin Scale (mRS) scores, and 90-day mortality.
- Statistical analysis identified independent risk factors for favorable outcomes.
Main Results:
- A total of 231 patients were analyzed (167 ACO, 64 PCO).
- Successful recanalization was achieved in 90.04% of patients.
- Favorable outcomes (mRS 0-2) were observed in 51.08% at 3 months, with an 18.61% mortality rate.
- Younger age, lower NIHSS, higher recanalization rates, and shorter OTR times predicted favorable outcomes.
- PCO patients had lower favorable outcome rates and higher mortality compared to ACO patients.
Conclusions:
- EVT is a safe and effective treatment for LVO-caused AIS.
- Key predictors of favorable outcomes include younger age, lower baseline NIHSS, successful recanalization, and shorter onset-to-recanalization times.
- Posterior circulation occlusion is associated with poorer outcomes and higher mortality than anterior circulation occlusion.
Abstract:
Endovascular treatment (EVT) has been strongly recommended as a first-line treatment for acute ischemic strokes (AIS) caused by large vessel occlusion (LVO). To evaluate the efficacy, safety, and predictors of favorable outcomes of EVT for LVO-caused AIS in both the anterior and posterior circulations, consecutive patients who had undergone EVT for AISs caused by LVO were retrospectively enrolled, and the clinical data, symptomatic intracranial hemorrhage (sICH), modified Rankin Scale (mRS) score, and mortality at 90 days were analyzed. In total, 231 patients were enrolled with a mean age of 63.25 ± 11.48 years, including 167 (72.29%) patients with anterior circulation occlusion (ACO) and 64 (27.71%) patients with posterior circulation occlusion (PCO) treated with EVT. The median baseline National Institutes of Health Stroke Scale (NIHSS) Score on admission was 17 (12-20). The median time from symptom onset to recanalization (OTR) was 380 (307.5-461) minutes. Successful recanalization was achieved in 90.04% of patients. At 3-month follow-up, 118 (51.08%) patients had favorable clinical outcomes (mRS 0-2), with a mortality rate of 18.61% (43/231). Younger age (p = 0.001), a lower baseline NIHSS score (p < 0.001), a higher recanalization rate (p = 0.018), and shorter OTR time (p = 0.026) were significant independent risk factors for favorable outcomes. Compared to patients with ACO, PCO patients had a lower favorable outcome rate (p = 0.049) and a higher mortality rate (p < 0.001). In conclusion, EVT is safe and effective for patients with LVO-caused AIS, and younger age, lower baseline NIHSS scores, a higher recanalization rate, and shorter OTR time are independent risk factors for favorable outcomes. PCO patients may have worse clinical outcomes and a higher mortality rate than ACO patients.
