Long-term follow-up of patients after endovascular treatment in acute ischemic stroke

Aim: The aim of this study was to follow up recanalization rates, clinical improvement, early and late complications and mortality rates in patients presenting to the Karadeniz Technical University Faculty of Medicine with acute stroke symptom, diagnosed with acute ischemic stroke, considered suitable for endovascular treatment (EVT) according to the 2015 stroke treatment guideline and who undergoing EVT. Method: One hundred patients diagnosed with acute ischemic stroke between February 2016 and August 2019, scheduled for acute term treatment and for whom it was decided to use EVT, were prospectively included in this study. Patients' demographic characteristics, ischemic stroke risk factors, National Institutes of Health Stroke Scale (NIHSS) scores at time of admission, symptom onset time, time of admission to hospital, iv tPA onset time in patients receiving thrombolytic therapy, groin puncture-recanalization time, extracranial and intracranial complications and post-procedure TICI scores were recorded. The patients were followed up prospectively, and their mRS values at one and three months an done year. Third month mRS 0-2 was evaluated as a good clinical outcome. Patients were divided into subgroups based on TICI scores, age, time elapsed between symptom onset and groin puncture, NIHSS scores, and treatment characteristics, and were subjected to analysis. Results: The mean age of the patients was 69.24 ± 13.32. Fifty-five (55%) were female and 45 (45%) were male. Sixty-eight (68%) patients had NIHSS scores below 15, while 32 (32%) had scores of 15 or above. Fifty-seven patients underwent IV tPA + EVT, while 43 received EVT only. Mean symptom onset to groin puncture time was 237.92 ± 104.31 (42-720) minutes, and mean groin puncture to recanalization time was 52.98 ± 38.36 (7-254) minutes. Adequate recanalization (TICI 2b-3) was observed in 75 patients (75%) after the procedure. The third-month functional independence rate was 22% (mRS≤2), the third-month mortality rate was 49%, and the symptomatic intracranial bleeding rate was 24%. At subgroup analysis based on groin puncture time, the successful recanalization rate was 79.2% in patients with a groin puncture time <240 minutes, and 70.2% in patients with a groin puncture time above ≥240 minutes. In addition, the rate of functional independence at the third month in the patients with a groin puncture time <240 minutes was 24.5%, and 19.1% in patients with a groin puncture time ≥240 minutes. Although these were not statistically significant, the successful recanalization rate and third-month functional independence rate were higher in patients with early groin puncture times (p: 0.418 and p: 0.685, respectively). At subgroup analysis based on age, third-month functional independence rate was 34.4% in patients under 65, and 16.2% in patients over 65, and although the difference was not statistically significant, the result was better in the under 65 group (p: 0.073). No difference was determined in terms of successful recanalization at subgroup analysis based on NIHSS scores. Although the difference was not V statistically significant, the group with NIHSS scores below 15 (27.9%) had a higher rate of third-month functional independence than the group with NIHSS scores above 15 (9.4%) (p: 0.067). While no statistically significant difference was observed in the results of patients with (24%) and withouth (76%) symptomatic intracranial bleeding, the proportion of patients over 65 years was higher among patients with symptomatic bleeding (p: 0.274), and groin puncture time was longer (p: 0.175). The proportion of patients with an ASPECT score <7 was also higher in the group with symptomatic bleeding (p: 0.153). At analysis of time-related parameters, the mean time between symptom onset to door was 127.06 minutes, and most of the time lost was spent before reaching the emergency department door. Conclusion: Endovascular treatment has proven its effectiveness in the light of large-scale, randomized studies conducted in recent years, and has been adopted in current guidelines. Although the aim of the treatment is to successfully recanalize the occluded vessel and restore perfusion, several factors affect the success of the treatment and patients' functional independence rates. The results of the present study confirm this and emphasize the importance of appropriate patient selection before EVT. It should not be forgotten that the benefit of treatment decreases and the rate of complications increases in line wtih the time elapsed between onset of symptoms and the groin puncture. Shortening this period, ensuring rapid patient acsess to centers where endovascular procedures are performed, and selecting appropriate patients capable of benefiting from EVT, through rapid evaluation will increase the benefit of EVT in patients with acute ischemic stroke.