Extent of investigation and classification criteria impact etiologies of ischemic stroke in the young

Abstract

Background: In the treatment of acute middle cerebral artery occlusion (MCAo), endovascular treatment (EVT) becomes preferred recanalization method. EVT comprises also percutaneous transluminal angioplasty (PTA) and mechanical thrombectomy (MT); only limited data are available regarding their comparison. Objective: To evaluate safety and efficacy of PTA and MT in the treatment of acute MCAo, including intravenous thrombolysis (IVT) with subsequent EVT, and to identify outcome predictors. Patients and methods: In the retrospective study, data from the Czech national multicenter registry of cerebral mechanical recanalizations were analyzed. The set consisted of 126 acute ischemic stroke patients (64 males; mean age 68.0 ± 13.3 years) with radiologically confirmed MCAo. Patient approval was obtained, as necessary. Results: Good 90-day clinical outcome (mRS 0-2) was achieved more frequently in patients treated with IVT + MT (56.4%) than with IVT + PTA (33.3%) (P = 0.04). Other differences found between the particular groups (PTA, MT, IVT + PTA, IVT + MT) were not statistically significant: successful recanalization in 89.1%, 93.1%, 86.7% and 91.4%, resp., and good 90-day clinical outcome in 41.1%, 51.0%, 33.3% and 56.4%, resp. (P N 0.05 in all cases). Diastolic blood pressure on admission (OR = 0.940, 95% CI: 0.902-0.980, P = 0.004) and neurologic deficit at the time of treatment (OR = 0.820, 95% CI: 0.728-0.922, P = 0.001) were identified as independent negative predictors and, achieved recanalization -TICI 2-3 (OR = 20.8, 95% CI: 1.400-319.1, P = 0.029) as an independent positive predictor of good 90-day clinical outcomes. Conclusion: Data from this registry showed that both PTA and MT represented safe and effective recanalization methods of acute MCAo.