Acute ischemic stroke caused by terminal internal carotid artery occlusion that meets the criteria for intravenous thrombolysis: a comparison between direct and bridging intravascular thrombectomy / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the clinical efficacy and safety of direct and bridging intravascular thrombectomy for patients with acute ischemic stroke due to terminal internal carotid artery occlusion.Methods:Patients with acute ischemic stroke due to terminal internal carotid artery occlusion and treated with endovascular thrombectomy (EVT) in the Department of Neurology, the Affiliated Lu'an Hospital of Anhui Medical University from January 2014 to December 2018 were enrolled retrospectively. All patients met the criteria of intravenous thrombolytic therapy. The patients were divided into direct EVT (DEVT) group and bridging thrombectomy group according to whether they received intravenous thrombolytic therapy. The baseline data, recanalization rate, incidence of symptomatic intracranial hemorrhage (sICH) and clinical outcomes were compared between the two groups. The clinical outcome was evaluated with the modified Rankin Scale at 90 days after stroke onset, and good outcome was defined as 0-2. Multivariate logistic regression analysis was used to identify the independent related factors of poor outcomes. Results:A total of 74 patients with terminal internal carotid artery occlusion were enrolled, including 40 in the DEVT group and 34 in the bridging thrombectomy group. There were no significant differences in demographic and baseline data between the two groups. The time from onset to imaging examination in the DEVT group was significantly longer than that in the bridge thrombectomy group ( P=0.005). However, there were no significant differences in the time from femoral artery puncture to vascular recanalization, the successful recanalization rate, the incidence of sICH, as well as the good outcome rate and mortality rate at 90 d between the DEVT group and the bridging thrombectomy group. Multivariate logistic regression analysis showed that advanced age (odds ratio [ OR] 1.061, 95% confidence interval [ CI] 1.007-1.118; P=0.027), higher baseline National Institutes of Health Stroke Scale score ( OR 1.160, 95% CI 1.049-1.283; P=0.004) and sICH ( OR 13.032, 95% CI 1.387-122.457; P=0.025) were independently associated with the poor outcomes. Conclusion:For patients with acute ischemic stroke due to terminal internal carotid artery occlusion, the efficacy and safety of DEVT treatment are equivalent to bridging treatment.