Endovascular Treatment for Acute Ischemic Stroke: Experience in South Australia

Abstract

Recent evidence from the MR CLEAN (1), EXTEND-IA (2), and ESCAPE (3) trials showed intra-arterial treatment in acute ischemic stroke caused by proximal intracranial arterial occlusion resulted in better functional outcomes at 90 days when compared with standard treatment. This contests prior evidence from randomized controlled trials indicating nonsuperiority of endovascular therapy (4-6). We conducted a retrospective analysis of 31 consecutive patients treated with endovascular therapy for acute ischemic stroke between November 2008 and December 2012 at The Queen Elizabeth Hospital, a tertiary referral center at a time of change in South Australia (7). Baseline characteristics and type of endovascular method are outlined in Table 1. Outcomes were assessed using Arterial Occlusive Lesion (AOL) recanalization scores and 90-day Modified Rankin Scores (mRS) (Table 2). Successful recanalization, defined by AOL 2-3, was achieved in 77•4% of our patients. This was lower than MR CLEAN (1) and EXTEND-IA (2), comparable to ESCAPE (3) and IMS III (6) but higher than MR RESCUE (4). Our patient group had higher rates of death, intracranial hemorrhage (ICH), and worse functional outcomes than reported in EXTEND-IA, MR CLEAN, IMS III, and SYNTHESIS (1,2,5,6). However, our study showed better functional outcomes, and ICH was less common than in MR RESCUE (4). We used multiple endovascular modalities, which limits comparison of our results; later-generation mechanical devices may contribute to improved rates of recanalization seen in the more recent