Pognosis of ischemic stroke outcomes with acute occlusion of a large cerebral vessel after endovascular thrombectomy

One of the priority areas in reducing mortality from acute ischemic stroke (IS) with acute occlusion of a major cerebral vessel is the search for active methods to restore cerebral blood flow. In recent years, the use of thrombolytic therapy and endovascular thrombectomy (EVT) has gained recognition. At the stage of actively implementing new methods of brain revascularization, predicting the outcomes of drug and mechanical recanalization of cerebral vessels is a pressing issue.

Objective. To scientifically justify and develop methods for predicting the outcomes of endovascular treatments for large-vessel cardioembolic and atherothrombotic subtypes of ischemic stroke.

Material and methods. The study included 324 patients treated for acute largevessel IS. Of these, 163 operated patients were included in the main “Group 1,” while 28 operated patients made up the control “Group 2.” “Group 0” consisted of 133 patients who received only medical therapy. Each group was divided into subgroups with cardioembolic (CEI) and atherothrombotic (ATI) subtypes of strokes. A multifactorial analysis was performed assessing clinical signs (neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), functional outcome according to the modified Rankin scale), hemodynamic parameters before and after surgery, echocardiography data, laboratory indicators, neuroimaging data before and after thrombectomies, and analysis of surgical techniques to identify factors contributing to favorable and unfavorable stroke outcomes.

Results. The significance of clinical and instrumental predictor signs for EVT outcomes in IS was determined. Based on discriminant analysis, a decision rule was obtained for predicting likely favorable and unfavorable outcomes after EVT in patients with cardioembolic and atherothrombotic subtypes of IS, demonstrating sensitivity and specificity exceeding 90%. Preventive tactics for emergency brain revascularizations and early therapeutic rehabilitation measures in a number of patients with an unfavorable prognosis allowed mortality to be reduced to 14.3% and achieved better functional outcomes in 60% of patients (NIHSS < 4 points, mRS 0–2).

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