Mechanical thrombectomy (MT) has been accepted as a standard treatment worldwide for patients suffering from acute anterior large vessel occlusion (AC-LVO) who can start early MT within 6 hours. However, in Vietnam, there remains a paucity of information regarding factors that can affect outcomes following this treatment. This study aimed to assess the clinical, imaging, and procedural factors related to good outcomes after MT for patients with AC-LVO within 4.5 hours. We analyzed data from 120 patients at Bach Mai hospital who had acute ischemic stroke (AIS) due to AC-LVO and were treated with MT with and without intravenous thrombolysis (IVT) within 4.5 hours from December 2020 to September 2022. Logistic regression analysis was used to examine the associations of clinical, imaging, and procedural variables with a good outcome. Overall, successful revascularization was achieved in 102/120 cases (85.0%) and 70 patients (58.3%) had a good outcome at 90 days. Successful revascularization (OR, 1.40; 95% CI, 1.24-1.58; p<0.01), initial blood glucose level (OR, 0.86; 95% CI, 0.85-0.87; p=0.046), and hemorrhagic transformation (OR, 0.83; 95% CI, 0.76-0.90; p=0.02) were independent factors associated with good outcome at 90 days.

This study reports the initial results of wide-necked bifurcation aneurysms treated with Woven EndoBridge (WEB) system at one of the first centers in Southeast Asia from April 2019 to June 2022. A total of 12 patients (50% female, median age of 66) with 12 aneurysms (9 unruptured and 3 ruptured) were recruited. The aneurysms were located in the basilar apex (4 patients), anterior communicating artery (4 patients), middle cerebral artery (3 patients), and posterior cerebral artery (1 patient). The average aneurysm size was 6.3mm (range 4.8 - 8.0mm) with mean dome to neck ratio of 1.2 and mean neck size of 5.4 mm (range 3.7 - 6.9mm). The technique was successful in all cases (100%) without any adjunctive devices. No intraoperative rupture occurred. Thromboembolic complications that occurred in two patients resulted in death in 1 patient (accompanied by retroperitoneal bleeding) (1/12, 8.3%) and moderate disability in 1 patient (1/12, 8.3%). The MRI follow-up at 3 months showed complete occlusion in 6 aneurysms (6/11, 54.5%) and neck remnant in 5 aneurysms (5/11, 45.5%). The study demonstrated that the WEB system alone was feasible to treat both ruptured and unruptured wide-necked bifurcation aneurysms. This device seems to be a promising tool for the treatment of complex wide-necked bifurcation aneurysms.

Evaluation of the results of mechanical thrombectomy (MT) with acute ischemic stroke (AIS) due to large vessel occlusions (LVO) at Bach Mai hospital. 227 patients with acute ischemic stroke due to large vessel occlusion were treated at Bach Mai Radiology Center from January 2018 to June 2019. Patients were divided into sub-groups depending on the treatment method. Successful recanalization rate (TICI 2b-3), good clinical recovery (mRS ≤2) after 3 months and other clinical and imaging features were analyzed and compared. The mean age was 65 ± 13 with 55% males. The NIHSS, ASPECTS and pc-ASPECTS baseline were 14.3, 7.7 and 7.6 with the distribution of occlusion sites as 23.8% ICA, 41.9% M1, 13.2% M2, 11.5% Tandem and 9.7% BA. The ratio of good revascularization (TICI 2b-3) was 84.6% after first-choice devices of 93 stent retriever (41%), 90 aspiration (40%) and 44 Solumbra (19%) – no significant difference seen (p > 0.05). 3 months after treatment, patients with good clinical recovery (mRS ≤ 2) accounted for 65.2% while intracranial symptomatic hemorrhage rate was only 3.5%. Thrombectomy for AIS patients due to LVO is very effective with high rate of good revascularization and clinical recovery. Using different mechanical devices at first pass (stent, aspiration or solumbra) do not correlated to any significantly different results.