Effects of mechanical thrombectomy for acute stroke patients with etiology of large artery atherosclerosis

Bo Sun; Zhonghua Shi; Jie Pu; Shiquan Yang; Huaiming Wang; Dong Yang; Yonggang Hao; Min Lin; Wei Ke; Wenhua Liu; Fuqiang Guo; Yongjie Bai; Shuai Zhang; Zibao Li; Shun Li; Meng Zuo; Gelin Xu; Wenjie Zi; Xinfeng Liu

doi:10.1016/j.jns.2018.10.017

Effects of mechanical thrombectomy for acute stroke patients with etiology of large artery atherosclerosis

J Neurol Sci. 2019 Jan 15:396:178-183. doi: 10.1016/j.jns.2018.10.017. Epub 2018 Oct 19.

Authors

Bo Sun¹, Zhonghua Shi², Jie Pu³, Shiquan Yang⁴, Huaiming Wang⁵, Dong Yang⁶, Yonggang Hao⁷, Min Lin⁸, Wei Ke⁹, Wenhua Liu¹⁰, Fuqiang Guo¹¹, Yongjie Bai¹², Shuai Zhang¹³, Zibao Li¹⁴, Shun Li³, Meng Zuo¹⁵, Gelin Xu¹⁶, Wenjie Zi¹⁷, Xinfeng Liu¹⁸

Affiliations

¹ Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Neurology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China.
² Department of Neurosurgery, The 101(st) Hospital of The People's Liberation Army, Wuxi, Jiangsu, China.
³ Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China.
⁴ Department of Neurology, The 123(rd) Hospital of The People's Liberation Army, Bengbu, Anhui, China.
⁵ Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China; Department of Neurology, The 89(th) Hospital of The People's Liberation Army, Weifang, Shandong, China.
⁶ Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China.
⁷ Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China; Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
⁸ Department of Neurology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, Fujian, China.
⁹ Department of Neurology, Hubei Zhongshan Hospital, Wuhan, Hubei, China.
¹⁰ Department of Neurology, Wuhan No. 1 Hospital, Wuhan, Hubei, China.
¹¹ Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China.
¹² Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Neurology, First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, China.
¹³ Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China.
¹⁴ Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China.
¹⁵ Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China.
¹⁶ Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
¹⁷ Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China. Electronic address: ziwenjie1981@163.com.
¹⁸ Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China. Electronic address: xfliu2@vip.163.com.

PMID: 30476651
DOI: 10.1016/j.jns.2018.10.017

Abstract

Aims: Atherosclerosis is more prevalent in Asian population. This distinct etiology of stroke might disadvantage Asian patients when applying. mechanical thrombectomy (MT). The purpose of this research was to evaluate the efficacy and safety of MT in a cohort of Chinese patients with acute ischemic stroke. due to large artery atherosclerosis (LAA).

Methods and results: A total of 649 patients treated with MT were included. Patients were classified according to etiology of stroke as LAA and cardioembolism ones. Successful revascularization was defined as modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b. Favorable outcome was defined as modified Rankin Scale (mRS) score ≤ 2 at 90 days. Logistic regression was used to identify predictors for functional outcomes. The patients with stroke of LAA etiology had significantly higher rate of favorable functional outcome (50.2% vs 36.5%, p < .001) and good collateral (grade of ASITN/SIRI: 2-3) (58.8% versus 43.2%, p < .001), and lower median baseline National Institutes of Health Stroke Scale score (NIHSS) (15.6 versus 18.2, p < .001), compared to patients with stroke of cardioembolism etiology. There was no significant difference in the rate of successful postprocedural mTICI between groups (84.5% versus 83.2%, p = .671). Rates of symptomatic intracranial hemorrhage (20.0% versus 11.7%, p = .004) and mortality (31.8% versus 18.8%, p < .001) within 3 months were notably higher in the cardioembolism group than that in the LAA group.

Conclusion: Mechanical thrombectomy may be more efficacious in treating acute ischemic stroke of LAA etiology than that of cardioembolism etiology.

Keywords: Acute ischemic stroke; Cardioembolism; Etiology; Large artery atherosclerosis; Mechanical thrombectomy.

Publication types

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

MeSH terms

Aged
Atherosclerosis / etiology*
Atherosclerosis / surgery*
Blood Pressure
Female
Follow-Up Studies
Humans
Logistic Models
Male
Middle Aged
Middle Cerebral Artery / physiopathology*
Outcome Assessment, Health Care
Stroke / complications*
Stroke / surgery*
Thrombectomy / methods*