Background The outcome of patients in acute ischemic stroke (AIS) due to a large artery occlusion (LAO) with high NIHSS (10 or higher), who recanalize less than 3 h of symptoms versus those more than 3 h, has not been clearly investigated. Therefore, these patients may encounter delay in enrollment for appropriate therapy such as stent retriever thrombectomy (SRT) resulting in delay in recanalization, which may not guarantee a good outcome. Despite the positive result, MR CLEAN trial demonstrated good functional outcome only 32% of patients in endovascular arm which may be responsible for delay in the enrollment (average 4 h).
Objective The objective of our study is to determine the predictor of functional outcome in AIS patients with high NIHSS who underwent SRT from middle cerebral artery (MCA) occlusion. Additionally, we compared the radiographic and functional outcome of those who recanalized less than hours versus whose more than 3 h.
Method We analyzed data from consecutive AIS patients of MCA occlusion with NIHSS ≥8 who underwent SRT were enrolled from 2012 to 2014. Demographics characteristics, time of stroke onset, time of intervention, time of recanalization from groin puncture, time of recanalization since symptoms, baseline NIHSS, 24 h and 30 days after the procedure, and 30 days modified Rankin Scale (mRS) were ascertained. The time of recanalization since symptoms is defined by the time interval between recanalization and symptoms onset. Outcome was measured by mRS at 30 days, NIHSS score after completion, 24 h and 30 days of the procedure. The SAS software was used to analyze the data.
Results We analyzed 21 AIS patients (67% female and 33% male) who underwent SRT for MCA occlusion (52% (11) right MCA, 48% (10) left MCA) with mean age of 70.62 ± 13.94 years and mean admission NIHSS 16.76 ± 5.09. Complete (TICI3) and partial (TICI2b) recanalization was observed in 19(90.50%) and 2(9.50%) respectively with mean passes of 1.71 ± 1. Time to recanalization from stroke onset was 230 ± 1160 min. Mean presenting NIHSS of 16.76 dropped to 7, 5 and 2 at immediate, 24 h and 30 days post SRT respectively. Good outcome (mRS ≤2) was observed in 15(66.13%) and poor outcome in 6(28.57%) including mortality in 2(9.5%). In univariate analysis recanalization time, immediate and 24 h post SRT NIHSS were predictors of outcome (p-value = 0.0039, 0.003 and 0.043 respectively). Patient’s age, gender and presenting NIHSS were not predictors of outcome.
Conclusions Our study demonstrates that patients with LAO from MCA who recanalize less than 3 h of symptoms onset have very good chance of good outcome (0–2) compared to those who recanilize more than 3 h. Therefore, all AIS patients with LAO should offer early SRT to achieve a good functional outcome. Further studies are required.
Disclosures Y. Lodi: None. V. Reddy: None. A. Devasenapathy: None. A. Hourani: None. C. Chou: None.
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