Chinese Journal of Contemporary Neurology and Neurosurgery (Nov 2024)

Long⁃term prognosis of endovascular treatment in patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window

  • LIU Shu⁃ling,
  • XU Yong⁃bo,
  • LI Yang,
  • WANG Si⁃fei,
  • LUO Lei⁃lei,
  • WEI Ming

DOI
https://doi.org/10.3969/j.issn.1672⁃6731.2024.11.010
Journal volume & issue
Vol. 24, no. 11
pp. 933 – 942

Abstract

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Objective To evaluate the long⁃term prognosis in patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window (> 24 h) who received endovascular treatment (EVT) combined with best medical treatment (BMT), compared to those treated with BMT alone. Methods This study included 158 patients from a prospective cohort of acute ischemic stroke due to large vessel occlusion were conducted at Tianjin Huanhu Hospital from November 2021 to July 2023. The 158 patients with anterior circulation large vessel occlusion were divided into received EVT combined with BMT (EVT group, n = 70) and received BMT alone (BMT group, n = 88). Long ⁃ term neurological prognosis was assessed using the modified Rankin Scale (mRS) 12 months after onset. Univariate and multivariate stepwise Logistic regression analyses were useded to investigated the risk factors of long⁃term neurological prognosis. Sensitivity analyses were performed using propensity score matching (PSM) and multiple imputation (MI). Results Logistic regression analysis showed that EVT was a protective factor for good long ⁃term neurological prognosis (mRS score ≤ 2; OR = 3.110, 95%CI: 1.460- 6.620, P = 0.003), increasing age (OR = 0.955, 95%CI: 0.924-0.987; P = 0.007) and hypertension (OR = 0.418, 95%CI: 0.187-0.936; P = 0.034) were risk factors. In the sensitivity analyses of the primary outcome, both the PSM and MI datasets showed that the proportion of patients with a good long ⁃ term neurological prognosis was significantly higher in the EVT group compared to the BMT group (PSM: aOR = 3.610, 95%CI: 1.370-9.550, P = 0.010; MI: aOR = 3.870, 95%CI: 1.780-8.440, P = 0.000). The results were consistent with the main analysis. Conclusions Compared to BMT group, EVT group patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window was demonstrated a significantly better long⁃term neurological prognosis.

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