Predictive Factors of Outcome of Mechanical Thrombectomy After Acute Ischemic Stroke

Predictive Factors of Outcome of Mechanical Thrombectomy After Acute Ischemic Stroke

Predictive factors of outcome of mechanical thrombectomy after acute ischemic stroke

Acute ischemic stroke is one of the most common causes of disability, dementia and death in developing world. In Egypt, the total lifetime prevalence of ischemic stroke was 7.2/1,000 in the population aged 20 years and more . Although the intravenous thrombolysis is a treatment option within ≤ 4.5 hours after stroke onset, the mechanical thrombectomy can be performed within a more extended time window. A positive results of 5 recent randomized clinical trials are driven mainly from patients treated by mechanical thrombectomy within 6 hours from onset and they demonstrated a clear benefit for mechanical thrombectomy in combination with intravenous thrombolysis. More recent two randomized clinical trials DAWN and DEFUSE 3 demonstrated an overall benefit in functional outcome at 90 days in patients treated with mechanical thrombectomy within 6 to 24 hours or 6 to 16 hours form onset respectively with special criteria. A major issue remains as to identifying patients which likely to benefit from mechanical thrombectomy to improve selection and subsequently clinical prognosis .

These factors include:-

1. Time of presentation.
2. Age.
3. Clinical presentation.
4. Risk factors include Hyperglycemia, peripheral vessel disease, atrial fibrillation, coronary heart disease, hyperlipidemia, smoking, and history of pervious stroke,
5. Socioeconomic status.
6. Collateral and stroke core. In this study the investigators will evaluate prognostic factors influencing angiographic and clinical outcomes at discharge and at three months after mechanical thrombectomy of acute ischemic stroke within 24 hours.

Inclusion Criteria:

1. Age >18 years
2. Cerebral infarction in the anterior or posterior circulation (intracranial internal carotid artery, M1 or M2 middle cerebral artery, basilar or vertebral arteries) proven by Computed tomography angiography
3. With or without intravenous thrombolysis
4. Access to endovascular treatment within 24 hours from onset.
5. In selected patients with acute ischemic stroke within 6 to 24 hours of onset must meet DAWN or DEFUSE 3 eligibility criteria.

Exclusion Criteria:

1. Proven occlusion of the cervical carotid artery
2. Disability prior to the stroke (modified ranking scale >3)
3. Opposition of the patient or their family