Efficacy of endovascular treatment in acute cardioembolic large vessel occlusion of anterior circulation and its influencing factors

Abstract

Objective To investigate the efficacy of endovascular treatment (EVT) in acute cardioembolic large vessel occlusion (LVO) of anterior circulation and its influencing factors. Methods The clinical data of 83 patients with acute cardioembolic LVO of anterior circulation treated with EVT during June 2014 to June 2016 were analyzed retrospectively. The neurological outcomes in these patients were evaluated by National Institutes of Health Stroke Scale (NIHSS) on admission; cerebral vascular re-canalization after procedure was classified according to thrombolysis in cerebral infarction (TICI) grading; the recovery of neurological outcomes was classified by modified Rankin scale (mRS) at discharge. According to the mRS scores at discharge, these patients were divided into two groups: good curative effect group and poor curative effect group. Single factor analysis was performed on all clinical parameters that might influence the surgical outcomes; in addition, the influencing factors of surgical outcomes were analyzed by multiple factor Logistic regression analysis. Results Eighty-one patients (97.59%) had good re-canalization (TICI grading 2b-3) after EVT; 41 patients (49.40%) had better curative effect (mRS scores≤3 at discharge), and 42 patients (50.60%) had poor curative effect (mRS scores≥4 at discharge); postoperative hemorrhagic transformation appeared in 26 patients, and 16 patients (19.28%) accepted decompressive craniectomy resulting from massive cerebral infarction, severe encephaledema or hemorrhagic transformation, and had poor curative effect. The single factor analysis showed that the differences of NIHSS scores on admission, occlusion site, angiographic re-canalization, time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after operation between the good curative effect group and poor curative effect group were statistically significant (P<0.05); multiple factor Logistic regression analysis showed that NIHSS scores on admission, angiographic re-canalization, time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after procedure were significantly correlated to the treatment efficacy (OR= 1.171, 95% CI: 1.028-1.333, P=0.017; OR=3.623, 95% CI: 0.931-14.095, P=0.063; OR=1.012, 95% CI: 1.003-1.021, P=0.008; OR=3.146, 95% CI: 0.875-11.309, P=0.079). Conclusions Endovascular thrombectomy is an effective approach for cardioembolic acute anterior circulation stroke. Furthermore, the influential factors of surgical treatment are NIHSS scores on admission, angiographic re-canalization, time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after procedure. Key words: Acute ischemic stroke; Anterior circulation; Cardioembolism; Endovascular treatment; Efficacy; Influencing factor