Endovascular therapy of 623 patients with anterior circulation stroke

Stroke. 2012 Apr;43(4):1052-7. doi: 10.1161/STROKEAHA.111.639112. Epub 2012 Feb 23.

Abstract

Background and purpose: Endovascular therapy of acute ischemic stroke has been shown to be beneficial for selected patients. The purpose of this study is to determine predictors of outcome in a large cohort of patients treated with intra-arterial thrombolysis, mechanical revascularization techniques, or both.

Methods: We prospectively acquired data for 623 patients with acute cerebral infarcts in the carotid artery territory who received endovascular treatment at a single center. Logistic regression analysis was performed to determine predictors of outcome.

Results: Median National Institutes of Health Stroke Scale (NIHSS) at admission was 15. Partial or complete recanalization was achieved in 70.3% of patients; it was independently associated with hypercholesterolemia (P=0.02), absence of coronary artery disease (P=0.023), and more proximal occlusion site (P<0.0001). After 3 months, 80.5% of patients had survived, and 48.9% of patients reached favorable outcome (modified Rankin scale score 0-2). Good collaterals (P<0.0001), recanalization (P=0.023), hypercholesterolemia (P=0.03), lower NIHSS at admission (P=0.001), and younger age (P<0.0001) were independent predictors for survival. More peripheral occlusion site (P<0.0001), recanalization (P<0.0001), hypercholesterolemia (P=0.002), good collaterals (P=0.002), lower NIHSS (P<0.0001), younger age (P<0.0001), absence of diabetes (P=0.002), and no previous antithrombotic therapy (P=0.036) predicted favorable outcome. Time to treatment was only a predictor of outcome, when collaterals were excluded from the model. Symptomatic intracerebral hemorrhage occurred in 5.5% and was independently predicted by poor collaterals (P=0.004).

Conclusions: Several independent predictors for outcome and complications were identified. Unlike in intravenous thrombolysis trials, time to treatment was a predictor of outcome only when collaterals were excluded from the model, indicating the important role of collaterals for the time window.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Age Factors
  • Aged
  • Cerebral Infarction / mortality*
  • Cerebral Infarction / physiopathology
  • Cerebral Infarction / therapy*
  • Cerebrovascular Circulation
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Hypercholesterolemia / mortality
  • Hypercholesterolemia / physiopathology
  • Hypercholesterolemia / therapy
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Stroke / mortality*
  • Stroke / physiopathology
  • Stroke / therapy*
  • Survival Rate
  • Thrombolytic Therapy*