The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

The influence of occluded artery and etiology of acute ischemic stroke on the long term outcomes after thrombectomy. A PRAGUE-16 substudy.

DOI: 10.4244/EIJ-D-19-00997

1. Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
2. Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
3. Department of Epidemiology, Third Faculty of Medicine, Charles University and University Hospital Kralovska Vinohrady, Prague, Czech Republic
4. Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralvoske Vinohrady,, Prague, Czech Republic
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Aims. Thrombectomy is an effective treatment for acute ischemic stroke (AIS). The aim was to compare clinical outcomes with intracranial artery occlusion site among AIS patients treated in the setting of a cardiology cath-lab. 

Methods and results. Single center, prospective registry of 214 consecutive patients with AIS enrolled between 2012 and 2018. All thrombectomy procedures were performed in a cardiology cath-lab with stent retrievers or aspiration systems. The functional outcome was assessed by the modified Rankin scale (mRS) after 3 months. 

Ninety-three patients (44%) had middle cerebral artery (MCA) occlusion, 28 (13%) proximal internal carotid artery (ICA) oclussion, 27 (13%) tandem (ICA+MCA) occlusion, 39 (18%) terminal ICA (T-type) occlusion and 26 (12%) vertebrobasilar (VB) stroke. 

Favorable clinical outcome (mRS ≤ 2) was reached in 58% of MCA occlusions and in 56% of isolated ICA occlusions, but only in 31% of T-type occlusions and in 27% of VB stroke. Poor clinical outcome in T-type occlusions and VB strokes was influenced by the lower recanalization succes (mTICI 2b-3 flow) rates: 56% (T-type) and 50% (VB) compared to 82% in MCA occlusions, 89% in isolated ICA occlusions and 96% in tandem occlusions. 

Conclusions. Catheter-based thrombectomy achieved significantly better clinical results in patients with isolated MCA occlusion, isolated ICA occlusions or tight stenosis and tandem occlusions compared to patients with T-type occlusion and posterior strokes.

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