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Original research
Primary acute stroke thrombectomy within 3 h for large artery occlusion (PAST3-LAO): a pilot study
  1. Yahia Lodi1,2,3,
  2. Varun Reddy1,2,
  3. Gorge Petro1,
  4. Ashok Devasenapathy1,2,
  5. Anas Hourani3,
  6. Chun-An Chou3
  1. 1Department of Neurology, Neurosurgery and Radiology, SUNY Upstate Medical University Binghamton Clinical Campus, Johnson City, New York, USA
  2. 2UHS-Wilson Regional Medical Center, Johnson City, New York, USA
  3. 3Department of Systems Science and Industrial Engineering, Binghamton University, Binghamton, New York, USA
  1. Correspondence to Professor Yahia Lodi, Department of Neurology, Neurosurgery and Radiology, SUNY Upstate Medical University Binghamton Clinical Campus, 46 Harrison Street, Johnson City, NY 13790, USA; lodiy{at}upstate.edu

Abstract

Background and purpose In recent trials, acute ischemic stroke (AIS) from large artery occlusion (LAO) was resistant to intravenous thrombolysis and adjunctive stent retriever thrombectomy (SRT) was associated with better perfusion and outcomes. Despite benefit, 39–68% of patients had poor outcomes. Thrombectomy in AIS with LAO within 3 h is performed secondary to intravenous thrombolysis, which may be associated with delay. The purpose of our study is to evaluate the safety, feasibility, recanalization rate, and outcome of primary SRT within 3 h without intravenous thrombolysis in AIS from LAO.

Methods Based on an institutionally approved protocol, stroke patients with LAO within 3 h were offered primary SRT as an alternative to intravenous recombinant tissue plasminogen activator. Consecutive patients who underwent primary SRT for LAO within 3 h from 2012 to 2014 were enrolled. Outcomes were measured using the modified Rankin Scale (mRS).

Results 18 patients with LAO of mean age 62.83±15.32 years and median NIH Stroke Scale (NIHSS) score 16 (10–23) chose primary SRT after giving informed consent. Near complete (TICI 2b in 1 patient) or complete (TICI 3 in 17 patients) recanalization was observed in all patients. Time to recanalization from symptom onset and groin puncture was 188.5±82.7 and 64.61±40.14 min, respectively. NIHSS scores immediately after thrombectomy, at 24 h and 30 days were 4 (0–12), 1 (0–12), and 0 (0–4), respectively. Asymptomatic perfusion-related hemorrhage developed in four patients (22%). 90-day outcomes were mRS 0 in 50%, mRS 1 in 44.4%, and mRS 2 in 5.6%.

Conclusions Our study demonstrates that primary SRT in AIS from LAO is safe and feasible and is associated with complete recanalization and good outcome. Further study is required.

  • Thrombectomy
  • Stroke
  • Intervention

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