Long-term outcomes of acute ischemic stroke patients treated with endovascular thrombectomy: A real-world experience

Wenbo Zhao; Shuyi Shang; Chuanhui Li; Longfei Wu; Chuanjie Wu; Jian Chen; Haiqing Song; Hongqi Zhang; Yunzhou Zhang; Jiangang Duan; Wuwei Feng; Xunming Ji

doi:10.1016/j.jns.2018.03.004

Long-term outcomes of acute ischemic stroke patients treated with endovascular thrombectomy: A real-world experience

J Neurol Sci. 2018 Jul 15:390:77-83. doi: 10.1016/j.jns.2018.03.004. Epub 2018 Mar 4.

Authors

Wenbo Zhao¹, Shuyi Shang¹, Chuanhui Li², Longfei Wu¹, Chuanjie Wu¹, Jian Chen², Haiqing Song¹, Hongqi Zhang², Yunzhou Zhang¹, Jiangang Duan³, Wuwei Feng⁴, Xunming Ji⁵

Affiliations

¹ Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
² Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
³ Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address: djgpwhcuhk@hotmail.com.
⁴ Department of Neurology, Medical University of South Carolina, Charleston, USA.
⁵ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address: jixm@ccmu.edu.cn.

PMID: 29801912
DOI: 10.1016/j.jns.2018.03.004

Abstract

Background and purpose: Long-term follow-up of large trials have confirmed the superiority of endovascular thrombectomy (ET) for treating acute ischemic stroke (AIS). However, it is still unknown whether these results can be generalized to clinical practice. In this study, we aimed to determine the long-term outcomes of AIS post-ET in the real-world clinical practice.

Methods: This observational study is based on a single-center prospective registry study. AIS patients were treated with second-generation stent retrievers from December 2012 to April 2016. The primary outcome was modified Ranks scale (mRS) at the time of the latest assessment. Favorable outcome was defined as mRS scores 0-2, and the unfavorable outcome was defined as mRS scores 3-6.

Results: Eighty-nine AIS subjects with large artery occlusion in anterior circulation undergoing ET were eligible for analysis. Median follow-up duration was 20 months (interquartile range 6-32), and 47 subjects (53%) achieved favorable outcome whereas 17 subjects (19%) were functional dependence and 25 subjects (28%) died. Independent predicators for long-term unfavorable outcome were higher baseline National Institutes of Health Stroke Scale (NIHSS) score (odd ratio:1.21;95% confidence interval 1.09-1.35; p < 0.001) and symptomatic intracerebral hemorrhage (sICH) (odd ratio:16.45;95% confidence interval 1.34-193.44; p = 0.026). More subjects of large-artery-atherosclerosis underwent permanent intracranial stenting (22%vs.10%) as compared with those of cardioembolism, while subjects of cardioembolism were more likely to experience sICH (13%vs.8%) and died (32%vs.16%).

Conclusions: Over half of AIS patients can achieve favorable long-term outcomes post-ET. Higher baseline NIHSS scores and sICH are independently associated with unfavorable outcome. Overall, clinical practice in this single canter can replicate the long-term outcomes from the published endovascular clinical trials.

Keywords: Acute stroke; Cardioembolism; Large artery atherosclerosis; Thrombectomy; Treatment outcome.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Brain Ischemia / mortality
Brain Ischemia / surgery*
Endovascular Procedures*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prospective Studies
Recovery of Function
Recurrence
Seizures / epidemiology
Severity of Illness Index
Stroke / mortality
Stroke / surgery*
Thrombectomy*
Treatment Outcome