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Original research
Endovascular recanalization in patients with severely disabling non-acute ischemic stroke
  1. Xiaoya Wang1,
  2. Ye Li1,
  3. Ziwei Lu1,
  4. Yating Jian1,
  5. Nannan Han2,
  6. Lili Zhao1,
  7. Meijuan Dang1,
  8. Yulun Wu1,
  9. Tao Li1,
  10. Yuxuan Feng1,
  11. Yang Yang1,
  12. Wei Huang3,
  13. Lei Zhang1,
  14. Huqing Wang1,
  15. Ru Zhang1,
  16. Mingze Chang2,
  17. Guilian Zhang1
  1. 1 Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
  2. 2 Department of Neurology, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, Shannxi, China
  3. 3 Department of Medical Imaging, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi, China
  1. Correspondence to Guilian Zhang, Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; zhgl_2006{at}


Background It is unclear whether patients with severely disabling ischemic stroke (SDIS—that is, modified Rankin scale (mRS) scores of 3–5) benefit from non-acute endovascular recanalization (ER).

Objective To determine the effect of non-acute ER or medical treatment in severely disabled patients with non-acute ischemic stroke (mRS scores of 3–5).

Methods Between January 2018 and August 2021, non-acute patients with SDIS and large vessel occlusion were collected from two regional stroke centers. Patients who met the inclusion and exclusion criteria were assigned to two groups based on whether they underwent ER (ER group) or not (medical group). The primary functional outcome was the mRS score at 90 days. The primary safety outcomes were the recurrence of stroke and mortality.

Results Of the 325 patients with hypoperfusion cerebral infarction caused by large vessel occlusion, 63 met the inclusion criteria (32 patients in the ER group, 31 patients in the medical group). A favorable outcome (mRS score ≤2) occurred more often in the ER group than in the medical group (59.4% vs 22.6%, respectively; OR=0.12, 95% CI 0.02 to 0.58; P<0.01). There were no significant differences in new-onset ischemic stroke (6.3% vs 3.2%, respectively; P=1.000), symptomatic intracerebral hemorrhage (12.5% vs 0%, respectively; P=0.113), or mortality within 90 days (6.3% vs 6.5%, respectively; P=1.000) between the two groups. Preoperative mRS scores (OR=7.34, 95% CI 1.56 to 34.5; P=0.02) and ER (OR=0.12, 95% CI 0.02 to 0.58; P<0.01) were significantly associated with outcome.

Conclusion Our data suggest that patients with SDIS (mRS score 3–5) with smaller infarct cores and better collateral circulation can benefit from non-acute ER, with no additional perioperative complications or mortality.

  • Stroke
  • Atherosclerosis
  • Intervention
  • Blood Flow
  • Angioplasty

Data availability statement

Data are available upon reasonable request. No data are available.

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Data availability statement

Data are available upon reasonable request. No data are available.

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  • Contributors XW conceived and wrote the manuscript. YL, HW, RZ and MC designed the research. ZL, YJ, NH, LiZ, WH, and MD collected data. YW, YF, YY, and LeZ performed the data analysis. TL interpreted the data. GLZ critically revised the report, and accepted full responsible for the overall content. All authors read and approved the final manuscript.

  • Funding This work was supported by grants from the National Natural Science Foundation of China (81971116), the Shaanxi Provicial Key Research and Development Project of China (2019ZDLSF01-04).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.