Endovascular Treatment of Acute Ischemic Stroke: A 10-year Experience from Saudi Arabia

Since 2015, endovascular therapy (EVT) has become the standard of care for acute ischemic stroke with large vessel occlusion (LVO).

To study the clinical and radiological features and outcomes of patients who underwent EVT at a tertiary care center in Saudi Arabia.

This retrospective study included all patients who underwent EVT between January 2012 and December 2022 at King Abdulaziz Medical City, Riyadh. Demographic, clinical, and radiological variables were analyzed.

A total of 159 patients were included (males: 61%; mean age: 56.8 ± 14.1 years). Most patients had moderate (39%) to severe (45%) stroke. The commonest LVO was right middle cerebral artery (MCA; 38%), followed by left MCA (37%), and basilar artery (19%). The initial ASPECT score was 8.2 ± 1.4. The median door-to-groin time was 126 (IQR 102-152) minutes. Most (84%) received EVT within 6 hours, and intravenous tissue plasminogen activator was used in 78 (49%) patients. Successful recanalization (TICI2b and above) was achieved in 78%, with stent retriever 137 (87%) and aspiration 62 (40%) being the most common techniques. Peri-procedural complications and intraparenchymal hemorrhage were seen in 13% and 12% of the patients, respectively, while 9% required decompressive craniectomy. At discharge, 44 (28%) had modified Rankin score of 0-2; 37 (23%) died. Cardioembolic and large vessel strokes were more common in patients aged >60 years (P < 0.001). Females were more likely to have general anesthesia (P = 0.036) and require decompressive craniectomy (P = 0.003). Patients who had EVT after >6 hours were more likely to have very severe stroke (P = 0.005) and mortality (P = 0.001).

EVT was associated with good procedural outcomes, despite slightly delayed door-to-groin time. Patients in whom EVT was initiated after >6 hours were significantly more likely to have very severe stroke and higher mortality.