Endovascular therapy beyond 24 hours for anterior circulation large vessel occlusion or stenosis in acute ischemic stroke: a retrospective study

An Wen; Wen-Feng Cao; Chao Zhao; Ling-Feng Wu; Yong-Liang Zhou; Zheng-Bing Xiang; Wei Rao; Shi-Min Liu

doi:10.3389/fneur.2023.1237661

Endovascular therapy beyond 24 hours for anterior circulation large vessel occlusion or stenosis in acute ischemic stroke: a retrospective study

Front Neurol. 2023 Dec 6:14:1237661. doi: 10.3389/fneur.2023.1237661. eCollection 2023.

Authors

An Wen^#^{1

2}, Wen-Feng Cao^#^{1

2}, Chao Zhao³, Ling-Feng Wu^{1

2}, Yong-Liang Zhou^{1

2}, Zheng-Bing Xiang^{1

2}, Wei Rao^{1

2}, Shi-Min Liu^{1

2}

Affiliations

¹ Department of Neurology, Jiangxi Provincial People's Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China.
² Department of Neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China.
³ Department of Neurology, Shangrao Municipal Hospital, Shangrao, Jiangxi, China.

^# Contributed equally.

Abstract

Background: To assess the clinical and safety outcomes of endovascular treatment (EVT) administered more than 24 h after the onset of symptoms in patients with acute ischemic stroke resulting from anterior circulation large-vessel occlusion or stenosis (AIS-ACLVO/S).

Methods: We enrolled consecutive AIS-ACLVO/S patients who received EVT in our hospital between January 2019 and February 2022 and divided them into two groups based on the time from AIS onset to EVT: EVT < 24 h group and EVT >24 h group. The successful reperfusion (modified thrombolysis in cerebral infarction, [mTICI] ≥2b), 90-day modified Rankin Scale score (mRS), intracranial hemorrhage (ICH), and symptomatic ICH (sICH), as well as mortality, were analyzed in the two groups of patients.

Results: A total of 239 patients were included in the study, with 214 patients in the EVT < 24 h group (67.8 ± 0.8 years, 126 males) and 25 patients in the EVT > 24 h group (62.80 ± 2.0 years, 22 males). Both groups were similar in terms of hypertension, diabetes history, responsible vessels, and Alberta stroke program early computed tomography scores (p > 0.05). However, the EVT < 24 h group had significantly higher age, history of atrial fibrillation, proportion of patients receiving intravenous thrombolysis, and NIHSS scores before EVT than the EVT > 24 h group. AIS etiology differed between the groups, with more cases of large artery atherosclerosis in the EVT > 24-h group and more cases of cardioembolism in the EVT < 24-h group. Successful reperfusion (mTICI ≥2b), ICH, and sICH were similar between the groups. The 90-day functional independence rate (mRS ≤ 2) was significantly higher in the EVT > 24-h than in the EVT < 24-h group (80% vs. 39.7%, p < 0.001), while the 90-day mortality rate was lower in the EVT > 24-h group (0% vs. 24.8%, p < 0.001).

Conclusion: In our study, we found that EVT beyond 24 h of symptom onset in patients selected with multimodal MR screening, was associated with high functional independence rates and low mortality. Larger or randomized studies are needed to confirm these findings.

Keywords: acute ischemic stroke; delayed endovascular treatment; extended window; large vessel occlusion; magnetic resonance imaging.

Grants and funding

This work was supported by grant from Jiangxi Provincial Health Commission Foundation (NO. 202110007 and NO. 202310122).