Endovascular Treatment for Minor Acute Ischemic Strokes With Large Vessel Occlusion
Background It remains uncertain whether patients with minor acute ischemic stroke with large vessel occlusion benefit from endovascular treatment (EVT). We aim to evaluate the outcomes of EVT in minor acute ischemic stroke with anterior circulation large vessel occlusion. Methods and Results Based o...
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| Format: | Article |
| Language: | English |
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Wiley
2022-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027326 |
| _version_ | 1811170029914292224 |
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| author | Rui Xue Wansi Zhong Ying Zhou Yaode He Shenqiang Yan Zhicai Chen Jianan Wang Xiaoxian Gong Min Lou |
| author_facet | Rui Xue Wansi Zhong Ying Zhou Yaode He Shenqiang Yan Zhicai Chen Jianan Wang Xiaoxian Gong Min Lou |
| author_sort | Rui Xue |
| collection | DOAJ |
| description | Background It remains uncertain whether patients with minor acute ischemic stroke with large vessel occlusion benefit from endovascular treatment (EVT). We aim to evaluate the outcomes of EVT in minor acute ischemic stroke with anterior circulation large vessel occlusion. Methods and Results Based on a nationwide prospective stroke registry, patients with minor acute ischemic stroke with anterior circulation large vessel occlusion within 24 hours of onset were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone. Primary outcome was excellent functional outcome defined as modified Rankin Scale score 0 to 1 at 90 days. In addition, a multivariable logistic regression model was used to analyze the effect of EVT guided by perfusion imaging. A total of 572 patients with median age 68 years (interquartile range=60–77) and median National Institutes of Health Stroke score 3 (interquartile range =2–4) were identified and 123 patients were treated with standard medical treatment plus EVT. EVT was not associated with excellent functional outcome (unadjusted odds ratio [OR], 0.771 [95% CI, 0.516–1.151]; adjusted OR, 0.793 [95% CI, 0.515–1.219]; P=0.290). However, therapy selection guided by perfusion imaging was a modifier of EVT effect on outcomes, as EVT was significantly associated with excellent functional outcome (60.0% versus 50.8%, unadjusted OR, 1.451 [95% CI, 0.643–3.272]; adjusted OR, 2.849 [95% CI, 1.006–8.067]; P=0.049) but not with symptomatic intracerebral hemorrhage in the imaging‐guided group. Conclusions Although functional outcomes in minor acute ischemic stroke caused by anterior circulation large vessel occlusion were not improved from the routine use of EVT, our results suggested that EVT guided by perfusion imaging could be beneficial for those patients. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT 04487340. |
| first_indexed | 2024-04-10T16:50:45Z |
| format | Article |
| id | doaj.art-4890b6ab5d2243a3854060f36d37ffef |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T16:50:45Z |
| publishDate | 2022-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-4890b6ab5d2243a3854060f36d37ffef2023-02-07T16:03:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-12-01112410.1161/JAHA.122.027326Endovascular Treatment for Minor Acute Ischemic Strokes With Large Vessel OcclusionRui Xue0Wansi Zhong1Ying Zhou2Yaode He3Shenqiang Yan4Zhicai Chen5Jianan Wang6Xiaoxian Gong7Min Lou8Department of Neurology The Second Affiliated Hospital of Zhejiang University, School of Medicine Hangzhou ChinaDepartment of Neurology The Second Affiliated Hospital of Zhejiang University, School of Medicine Hangzhou ChinaDepartment of Neurology The Second Affiliated Hospital of Zhejiang University, School of Medicine Hangzhou ChinaDepartment of Neurology The Second Affiliated Hospital of Zhejiang University, School of Medicine Hangzhou ChinaDepartment of Neurology The Second Affiliated Hospital of Zhejiang University, School of Medicine Hangzhou ChinaDepartment of Neurology The Second Affiliated Hospital of Zhejiang University, School of Medicine Hangzhou ChinaDepartment of Neurology The Second Affiliated Hospital of Zhejiang University, School of Medicine Hangzhou ChinaDepartment of Neurology The Second Affiliated Hospital of Zhejiang University, School of Medicine Hangzhou ChinaDepartment of Neurology The Second Affiliated Hospital of Zhejiang University, School of Medicine Hangzhou ChinaBackground It remains uncertain whether patients with minor acute ischemic stroke with large vessel occlusion benefit from endovascular treatment (EVT). We aim to evaluate the outcomes of EVT in minor acute ischemic stroke with anterior circulation large vessel occlusion. Methods and Results Based on a nationwide prospective stroke registry, patients with minor acute ischemic stroke with anterior circulation large vessel occlusion within 24 hours of onset were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone. Primary outcome was excellent functional outcome defined as modified Rankin Scale score 0 to 1 at 90 days. In addition, a multivariable logistic regression model was used to analyze the effect of EVT guided by perfusion imaging. A total of 572 patients with median age 68 years (interquartile range=60–77) and median National Institutes of Health Stroke score 3 (interquartile range =2–4) were identified and 123 patients were treated with standard medical treatment plus EVT. EVT was not associated with excellent functional outcome (unadjusted odds ratio [OR], 0.771 [95% CI, 0.516–1.151]; adjusted OR, 0.793 [95% CI, 0.515–1.219]; P=0.290). However, therapy selection guided by perfusion imaging was a modifier of EVT effect on outcomes, as EVT was significantly associated with excellent functional outcome (60.0% versus 50.8%, unadjusted OR, 1.451 [95% CI, 0.643–3.272]; adjusted OR, 2.849 [95% CI, 1.006–8.067]; P=0.049) but not with symptomatic intracerebral hemorrhage in the imaging‐guided group. Conclusions Although functional outcomes in minor acute ischemic stroke caused by anterior circulation large vessel occlusion were not improved from the routine use of EVT, our results suggested that EVT guided by perfusion imaging could be beneficial for those patients. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT 04487340.https://www.ahajournals.org/doi/10.1161/JAHA.122.027326endovascular treatmentlarge vessel occlusionminor acute ischemic strokeperfusion imaging |
| spellingShingle | Rui Xue Wansi Zhong Ying Zhou Yaode He Shenqiang Yan Zhicai Chen Jianan Wang Xiaoxian Gong Min Lou Endovascular Treatment for Minor Acute Ischemic Strokes With Large Vessel Occlusion Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease endovascular treatment large vessel occlusion minor acute ischemic stroke perfusion imaging |
| title | Endovascular Treatment for Minor Acute Ischemic Strokes With Large Vessel Occlusion |
| title_full | Endovascular Treatment for Minor Acute Ischemic Strokes With Large Vessel Occlusion |
| title_fullStr | Endovascular Treatment for Minor Acute Ischemic Strokes With Large Vessel Occlusion |
| title_full_unstemmed | Endovascular Treatment for Minor Acute Ischemic Strokes With Large Vessel Occlusion |
| title_short | Endovascular Treatment for Minor Acute Ischemic Strokes With Large Vessel Occlusion |
| title_sort | endovascular treatment for minor acute ischemic strokes with large vessel occlusion |
| topic | endovascular treatment large vessel occlusion minor acute ischemic stroke perfusion imaging |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027326 |
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