Endovascular Therapy for Acute Ischemic Stroke in Patients with Large-Vessel Occlusion due to Atherosclerotic Stenosis

Manabu Shirakawa; Hidetoshi Matsukawa; Nobuyuki Sakai; Hiroshi Yamagami; Kanta Tanaka; Hirotoshi Imamura; Yasushi Matsumoto; Masataka Takeuchi; Hiroto Kageyama; Kazutaka Uchida; Takeshi Morimoto; Shinichi Yoshimura

doi:10.1016/j.jstrokecerebrovasdis.2021.105960

Endovascular Therapy for Acute Ischemic Stroke in Patients with Large-Vessel Occlusion due to Atherosclerotic Stenosis

J Stroke Cerebrovasc Dis. 2021 Oct;30(10):105960. doi: 10.1016/j.jstrokecerebrovasdis.2021.105960. Epub 2021 Jul 24.

Affiliations

¹ Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.
² Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
³ Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
⁴ Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
⁵ Department of Neuroendovascular Therapy, Kohnan Hospital, Miyagi, Japan.
⁶ Department of Neurosurgery, Seishou Hospital, Odawara, Japan.
⁷ Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
⁸ Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.

PMID: 34314984
DOI: 10.1016/j.jstrokecerebrovasdis.2021.105960

Abstract

Objectives: Endovascular therapy (EVT) is safe and effective for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). However, the influence of the AIS subtype (large-artery atherosclerosis [LAA] or cardioembolism [CE]) on clinical outcome in patients treated with EVT remains unclear. This study aimed to evaluate the differences in clinical results between the two subtypes using data from a multicenter prospective registry (RESCUE-Japan Registry 2).

Materials and methods: Among 2420 patients in RESCUE-Japan Registry, 682 patients who were diagnosed with LAA or CE were enrolled. The primary outcome was a modified Rankin Scale (mRS) score of 0-2 at 90 days. The secondary outcomes were 90-day mRS 0-1, 0-3, and 6. The relationship between time from onset and clinical outcome was also analyzed.

Results: Among the 682 patients, 124 were classified into the LAA group and 558 into the CE group. The baseline National Institutes of Health Stroke Scale score was significantly lower (median 15 vs. 18, p < 0.001). At 90 days, mRS 0-2 was observed in 54 of 124 patients (44%) in the LAA group and 232 of 558 patients (42%) in the CE group (p = 0.69). The proportion of patients with mRS 0-2 tended to decrease according to onset-to-puncture time in the CE group but not in the LAA group (p_trend=0.0007).

Conclusions: The rate of good outcome was similar between LVO due to LAA and CE. However, the rate of favorable outcome did not decrease according to onset-to-puncture time in the LAA group.

Keywords: Atherosclerosis; Endovascular treatment; Large-vessel occlusion; Stroke.

Publication types

Multicenter Study
Observational Study

MeSH terms

Aged
Aged, 80 and over
Carotid Artery, Internal* / diagnostic imaging
Carotid Artery, Internal* / physiopathology
Carotid Stenosis / diagnostic imaging
Carotid Stenosis / physiopathology
Carotid Stenosis / therapy*
Embolic Stroke / diagnostic imaging
Embolic Stroke / physiopathology
Embolic Stroke / therapy*
Endovascular Procedures* / adverse effects
Female
Functional Status
Humans
Infarction, Middle Cerebral Artery / diagnostic imaging
Infarction, Middle Cerebral Artery / physiopathology
Infarction, Middle Cerebral Artery / therapy*
Ischemic Stroke / diagnostic imaging
Ischemic Stroke / physiopathology
Ischemic Stroke / therapy*
Japan
Male
Middle Aged
Prospective Studies
Recovery of Function
Registries
Time Factors
Treatment Outcome