Mechanical Thrombectomy by Stent Retrievers for Treating Acute Ischemic Stroke due to Large Vessel Occlusion

Abstract

Background Recently multiple studies have evaluated the role of mechanical thrombectomy in treatment of acute ischemic stroke & demonstrated that it has a favorable impact on the functional outcome in patients with acute ischemic stroke related to proximal arterial occlusion. In addition to that, multiple systematic reviews and meta-analyses analyzed the results of these recent Randomized Control Trials and concluded that endovascular treatment is more likely to result in a better functional outcome for patients compared to IV thrombolysis alone for acute ischemic stroke due to large vessel occlusion, with no differences in mortality and symptomatic intracerebral hemorrhage at 90 days follow-up. Mechanical approaches have shown great potential of replacing locally applied thrombolytic agents as first-line therapy. Objectives The aim of work is to evaluate the safety and efficacy of endovascular treatment (EVT) of acute large vessel occlusion within the first 6 hours of symptoms onset, including bridging therapy [intravenous thrombolysis (IVT) with subsequent EVT]. We also compare our results to other main trials in recent years. Methods A one arm clinical trial was conducted on 25 patients with acute ischemic stroke at Ain Shams University hospitals as well as private centers, from the first of April 2020 to the end of September 2020. All participants subjected to full history taking, radiological assessment and assessment of the stroke severity. Results The median age of the studied patients was 64 years (Interquartile range 58-72.5) and about half (56%) of them were males. On pre-post intervention comparison, there was a highly significant statistical difference regarding NIHSS score, infarct volume, mRS score at 90 days (P < 0.001) and ASPECTS (P < 0.01) of the studied patients. 12% of patients had mortality at 30 days after mechanical thrombectomy with good functional outcome (mRS 0-2) rate of 60%. Conclusion Mechanical thrombectomy is effective and safe in treatment of acute ischemic stroke in patients with large cerebral artery occlusion with the first 6 hours of symptoms onset.