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Zhu CM, Li Q, Zeng W, Liu AF, Zhou J, Zhang M, Jiang YF, Li X, Jiang WJ. Safety and efficacy of endovascular recanalization in patients with mild anterior stroke due to large-vessel occlusion exceeding 24 hours. Int J Neurosci 2023:1-10. [PMID: 37458211 DOI: 10.1080/00207454.2023.2236781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Endovascular recanalization (ER) has demonstrated efficacy as a treatment modality for patients presenting with acute ischemic stroke (AIS) caused by large-vessel occlusion (LVO) within a 24-hour timeframe. Nevertheless, the safety and effectiveness of ER in patients with a time of onset exceeding 24 h remain uncertain. OBJECTIVE To evaluate the safety and efficacy of ER treatment for mild ischemic stroke beyond 24-h from symptom onset. METHODS A retrospectively maintained database of mild AIS due to LVO from March2018 to September 2022 at a comprehensive stroke center was screened.Patients received ER or standard medical therapies (SMT) for anterior circulation AIS due to LVO > 24-h were selected. RESULTS We included 47 LVO patients with mild AIS beyond 24-h who suffered neurological deterioration (ND). 34 of these patients underwent ER, the other 13 received SMT. The technical success rate of recanalization was 82.4% (28/34). Patients received ER had significantly lower NIHSS score at discharge and 90-day mRS score (p = 0.028, p = 0.037, respectively) compared to SMT. In addition, they had significantly lower 90-day recurrence of ischemic stroke and lower incidence of moderate-severe stroke (with a NIHSS score at least 5) (p = 0.037, p = 0.033). There were 4 patients (11.7%) had perioperative complications, and no symptomatic intracranial hemorrhage occurred. CONCLUSION ER treatment for mild AIS due to LVO encountered ND was generally safe and effective, even beyond 24-h, and resulted in a good prognosis and lower 90-day recurrence compared to SMT.
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Affiliation(s)
- Can-Min Zhu
- Department of Medicine, Soochow University School of Medicine, Suzhou, Jiang-su, China
- Department of Neurology, The First people's Hospital of Jiangxia District, Wuhan, Hu-bei, China
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
| | - Qiang Li
- Department of Neurology, Wuhan Fifth Hospital, Jianghan University School of Medicine, Wuhan, Hu-bei, China
| | - Wei Zeng
- Department of Neurology, Wuhan Fifth Hospital, Jianghan University School of Medicine, Wuhan, Hu-bei, China
| | - Ao-Fei Liu
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
| | - Ji Zhou
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
| | - Mei Zhang
- Department of Neurology, Wuhan Fifth Hospital, Jianghan University School of Medicine, Wuhan, Hu-bei, China
| | - Yuan-Feng Jiang
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
| | - Xia Li
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
| | - Wei-Jian Jiang
- Department of Medicine, Soochow University School of Medicine, Suzhou, Jiang-su, China
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
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Wu T, Shi Z, Chen B, Geng Y, Pan J. TCD hemodynamics findings in the subacute phase of anterior circulation stroke patients treated with mechanical thrombectomy. Open Med (Wars) 2022; 17:606-613. [PMID: 35434377 PMCID: PMC8961283 DOI: 10.1515/med-2022-0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 12/03/2022] Open
Abstract
Despite mechanical thrombectomy, the prognosis for many patients with anterior circulation ischemic stroke (ACIS) remains poor. This retrospective study reports consecutive mechanical thrombectomy procedures for ACIS at our hospital over 4 years. Hemodynamics were explored using transcranial Doppler ultrasound. The functional outcome was assessed using the modified Rankin scale. A total of 121 eligible cases were included: 61 (50.4%) exhibited good outcomes (modified Rankin scale score ≤2) by day 90. The logistic regression analysis showed that ipsilateral middle cerebral artery (iMCA) systolic blood flow (SBF) (OR = 0.983, 95% CI: 0.969–0.997, P = 0.014), preoperative National Institutes of Health Stroke Scale (NIHSS)score (OR = 1.160, 95% CI: 1.067–1.261, P < 0.001), intracranial hemorrhage after therapy (OR = 19.514, 95% CI: 4.364–87.265, P < 0.001), and Alberta Stroke Program Early Computed Tomography Score (OR = 0.639, 95% CI: 0.416–0.981, P = 0.040) were independently associated with prognosis. The iMCA SBF and preoperative NIHSS score were significantly predictive of a good outcome in the receiver operating characteristic analysis. In conclusion, elevated iMCA SBF might be a prognostic indicator of a good 90-day outcome following endovascular treatment in ACIS patients treated with mechanical thrombectomy, but large prospective studies are mandatory to validate the findings of our study.
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Affiliation(s)
- Tingting Wu
- Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College) , Hangzhou , 310014 , Zhejiang China
| | - Zongjie Shi
- Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College) , Hangzhou , 310014 , Zhejiang China
| | - Bo Chen
- Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College) , Hangzhou , 310014 , Zhejiang China
| | - Yu Geng
- Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College) , Hangzhou , 310014 , Zhejiang China
| | - Jie Pan
- Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College) , No. 158 Shangtang Road , Hangzhou , 310014 , Zhejiang China
- Medical College of Soochow University , Suzhou , 215123 , China
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