Abstract
Endovascular acute stroke treatment (AIS) has changed dramatically last years. Stent retrievers are progressively substituting other devices and old practices like intra-arterial thrombolysis. We present the subgroup analysis of the largest prospective multicentre study using stent retrievers on the treatment of AIS. The study was realized in 14 high volume and experienced stroke centres in Europe, Canada and Australia. 202 patients harbouring anterior circulation occlusions were included within 8 hours after onset. All procedures were performed with balloon guiding catheter. We observed that the occlusion location did not change the successful (TICI 2b or 3) recanalization rates (ICA - 76.5% and MCA - 86.4%: p=0.187) or good clinical outcomes (mRS 0-2) (ICA - 47.2% and MCA - 61.3%: p=0.137). However, it was significant when we considered excellent (mRS 0-1) outcomes only (ICA - 25% and MCA - 47.5%: p=0.016). There were no differences concerning the previous use of rtPA on the angiographic (TICI scores) (p=1.0) or clinical (mRS) (p=0.564) outcomes. The anaesthetic management also did not influence the revascularization (p=0.7) or patient’s status (p=0.343). Angiographic collateral status determined using the ASITN/SIR grading system was significantly correlated to good clinical outcomes (Grades 0-2 and Grades3-4, p=0.034). Also the time from the stroke onset to groin puncture influence clinical progress (0-3h, 3-4.5h, over 4.5h: p=0.002). Multivariate regression analysis on prediction of good outcomes was significant for age (OR-0.93 (0.89, 0.97)), baseline NIHSS (OR-0.87(0.79, 0.96)), absence of haemorrhage (OR-5.01 (1.65, 15.16)), time to treatment (OR-0.62(0.45-0.83)) procedure performed under conscious sedation (OR4.83(1.78,13.11)) and successful recanalization (OR-3.37(1.12,10.14)). Early and efficient revascularization is ideal situation for AIS. Conscious sedation can save time for endovascular procedure using a stent retriever in experienced centers.