Outcome Evaluation of Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy: A Single-Institution Experience in the Era of Randomized Controlled Trials

• Published in: World neurosurgery Vol. 99; pp. 593 - 598
• Main Authors: Sarzetto, Francesca, Gupta, Shaurya, Alotaibi, Naif M., Howard, Peter, da Costa, Leodante, Heyn, Chris, Maralani, Pejman Jabehdar, Guha, Daipayan, Swartz, Richard H., Boyle, Karl, Yang, Victor X.D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: Aged; Aged, 80 and over; Basilar Artery - surgery; Brain Ischemia - diagnostic imaging; Brain Ischemia - therapy; Carotid Artery Thrombosis - diagnostic imaging; Carotid Artery Thrombosis - therapy; Carotid Artery, Internal - surgery; Cerebral Angiography; Computed Tomography Angiography; Endovascular; Endovascular Procedures - methods; Female; Fibrinolytic Agents - therapeutic use; Humans; Infarction, Middle Cerebral Artery - diagnostic imaging; Infarction, Middle Cerebral Artery - therapy; Logistic Models; Male; Middle Aged; Middle Cerebral Artery - surgery; Neurosurgery; Randomized Controlled Trials as Topic; Retrospective Studies; Stroke; Stroke - diagnostic imaging; Stroke - therapy; Thrombectomy; Thrombectomy - methods; Time-to-Treatment; Tissue Plasminogen Activator - therapeutic use; Tomography, X-Ray Computed; Treatment Outcome; Vertebrobasilar Insufficiency - diagnostic imaging; Vertebrobasilar Insufficiency - therapy; NIHSS; Stroke; RCT; OR; ASPECTS; LVO; tPA; Endovascular; CI; MR CLEAN; IV; ESCAPE; mRS; CT; Thrombectomy; TICI; Alberta Stroke Program Early CT Score; Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; Randomized controlled trials; IV tPA; Thrombolysis in cerebral infarction; Computed tomography; Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times; RCTs; Intravenous thrombolysis with tissue plasminogen activator; Modified Rankin Scale; National Institutes of Health Stroke Scale; Large vessel occlusion
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.12.054

Endovascular thrombectomy is an effective procedure to treat selected ischemic strokes, as shown in recent randomized controlled trials (RCTs). The generalizability of these trial data to real-world settings, however, is unknown. The aim of this study was to examine our single-center experience with endovascular thrombectomy for acute ischemic strokes and perform a comparative outcome analysis to the most recent RCTs. We performed a 5-year retrospective analysis, from April 2011 to March 2016, on 66 consecutive patients with acute ischemic stroke who received endovascular thrombectomy at our institution. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale were used to assess preoperative status. Our primary outcomes were the modified Rankin Score (mRS) at 90 days and recanalization grade measured by the 6-point thrombolysis in cerebral infarction (TICI) grading system. Sixty-six patients received endovascular treatment during the study period. Among the patients examined, 35 (53%) had a favorable outcome (mRS 0–2 at 90 days), 23 (35%) a poor outcome (mRS 3–5), and 8 (12%) died. Successful recanalization (TICI score 3–5) was achieved in 68% of cases. In univariate analysis, patients with good outcome at 90 days had significantly greater ASPECTS, lower National Institutes of Health Stroke Scale, and higher TICI scores. In a multiple logistic regression model, higher ASPECTS and TICI scores were significantly and independently associated with favorable outcome. Excellent outcomes, as demonstrated by the recent RCTs, can be achieved in clinical practice and reproduced in dedicated tertiary centers.