Endovascular Treatment in Patients with Large Vessel Occlusion Stroke of Different Mechanisms
Abstract Introduction Acute ischemic stroke with large vessel occlusion (AIS-LVO) is mainly caused by in situ thrombosis (IST), artery-to-artery embolism (AAE), and cardioembolism (CE). The clinical characteristics and prognosis of each mechanism are unclear in a real-world scenario. Methods We retr...
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| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Adis, Springer Healthcare
2025-03-01
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| Series: | Neurology and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s40120-025-00727-9 |
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| Summary: | Abstract Introduction Acute ischemic stroke with large vessel occlusion (AIS-LVO) is mainly caused by in situ thrombosis (IST), artery-to-artery embolism (AAE), and cardioembolism (CE). The clinical characteristics and prognosis of each mechanism are unclear in a real-world scenario. Methods We retrospectively analyzed patients with AIS-LVO who underwent endovascular treatment (EVT) between April 2023 and August 2024. Patients were classified according to three mechanisms. This study aimed to compare the clinical characteristics, lab results, EVT procedural factors, and prognosis of patients with AIS-LVO with three different mechanisms. The modified Rankin Scale (mRS) score at 3 months was the primary outcome, which was analyzed by ordinal logistic regression. Results Among 162 patients included, IST (n = 81) was the most common mechanism, followed by CE (n = 41) and AAE (n = 40). Patients with CE showed more severe initial symptoms and the highest rate of intracranial hemorrhage. Patients with IST were associated with more rapid progression, more posterior circulation involvement, and higher inflammatory profile. Patients with AAE experienced a longer procedural time and had a higher rate of symptomatic intracranial hemorrhage (sICH). Although patients with IST and AAE more often required stenting, no significant difference in the rate of successful recanalization was found. The rates of mRS distribution (p = 0.24), and favorable outcomes at 3 months (p = 0.36) did not differ among the three groups. However, a trend towards better outcomes in the CE group was noted. On multivariable logistic regression, age (odds ratio, 0.97, 95% confidence interval, 0.95–1.00), pre-EVT National Institutes of Health Stroke Scale (NIHSS) (odds ratio, 0.94, 95% confidence interval, 0.89–0.98), and sICH (odds ratio, 0.33, 95% confidence interval, 0.12–0.95) could independently predict a favorable shift in mRS distribution. We failed to find that the mechanism was a predictor of the outcome. Conclusions The functional outcomes of patients with AIS-LVO were similar among different mechanisms, despite the sICH being much higher in patients with AAE. The optimal management for AIS-LVO with different mechanisms requires further research. |
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| ISSN: | 2193-8253 2193-6536 |