Safety and efficacy of intravascular therapy in patients with progressive stroke caused by intracranial large vascular occlusion exceeding the time window of 24 hours

Abstract

Purpose: To compare endovascular and drug therapies for efficacy and safety in patients with a progressive stroke caused by intracranial large vascular occlusion exceeding the time window of 24 hours. Patients and methods: A total of 58 patients with progressive stroke caused by large intracranial vascular occlusion exceeding the time window of 24 hours treated in the stroke center of our hospital for three years were retrospectively analyzed . According to the applied therapy, 58 patients were divided into the endovascular (n = 19) and drug (n = 39) therapy groups. Then, modified Rankin scale (mRS) scores, symptomatic intracranial hemorrhage rates, mortality rates and adverse events were assessed in both groups within 90 days. Results: The 90-day good prognosis rate was significantly higher in the endovascular therapy group compared with the drug group (68.4% VS 38.5%, odds ratio [OR] = 0.29; 95% confidence interval [CI], 0.09-0.92; P = 0.032). The 90-day NIHSS scores were lower in the endovascular therapy group compared with the drug group (3.3 ± 2.6 VS 5.2 ± 3.0, OR = −1.89; 95%CI, −3.50 to −0.27; P = 0.023). Meanwhile, the proportion of patients with a Barthel index of 90-100 was significantly higher in the endovascular therapy group compared with the drug group (53.0% VS 25.6%, OR = 0.31; 95%CI, 0.10-0.98; P = 0.042). Finally, both groups showed similar rates of adverse events. Conclusion:In patients with progressive stroke caused by large intracranial vascular occlusion exceeding 24 hours, endovascular therapy probably results in improved efficacy at 90 days compared with drug therapy, without increasing the rates of adverse effects.

Effect of medical care linkage-continuous management mode in patients with posterior circulation cerebral infarction undergoing endovascular interventional therapy

“…Improper heparin dosage and elevated blood pressure are important causes of postoperative intracranial hemorrhage. Vascular reopening and high perfusion can also cause secondary damage to the brain tissue, resulting in brain edema and intracranial hypertension[ 16 , 17 ]. Therefore, prevention and nursing of postoperative complications are key to the success of interventional surgery and rehabilitation of patients.…”

Safety and Efficacy of Endovascular Treatment for Progressive Stroke in Patients With Acute Basilar Artery Occlusion

“…The published literature reports outcomes of endovascular therapy in patients with progressive stroke in the anterior circulation compared with standard drug therapy. In trials of endovascular therapy for progressive ischemic stroke in anterior circulation large artery occlusion, the overall outcome of EVT was significantly better than drug therapy, even beyond the traditional 24-h time window, and endovascular therapy may improve neurological recovery within 90 days ( 9 , 10 ). Relatively few studies have been reported on patients with progressive stroke in BAO.…”

“…Recent studies have shown the effectiveness and safety of EVT in patients with progressive stroke due to large vessel occlusion in the anterior circulation. EVT has a better outcome than SMT without increasing the incidence of adverse events ( 9 , 10 ). And although EVT has been used in the past few years to treat BAO with a trend toward benefit, there are limited data on the efficacy and safety of EVT in progressive stroke.…”