Analysis Of The Effects And Predictors Of Endovascular Treatment For Acute Anterior Circulation Large Artery Occlusions Stroke With Etiology Of Large Artery Atherosclerosis And Cardioembolism

Aims: In 2015,the results of the five prospective randomized controlled studies published in ?The New England? have shown that the effects of endovascular treatment(EVT)is better than standard drug therapy for acute anterior circulation large artery occlusions srtoke.However,the effects of EVT may be affected by several factors.The influence of stroke etiology to ET is increasingly received attention.The purpose of this research was to anaysis the efficacy and predictors of EVT in a cohort of Chinese patients with acute ischemic stroke due to large artery atherosclerosis(LAA)and cardioembolism.Methods: A total of 649 patients treated with EVT were included.Patients were classified according to etiology of stroke as LAA and cardioembolism ones.Successful revascularization was defined as modified Thrombolysis in Cerebral Infarction(mTICI)grade ?2b.Favorable outcome was defined as modified Rankin Scale(mRS)score ?2 at 90 days.Logistic regression was used to identify predictors for functional outcomes.Results:The patients with stroke of LAA etiology had significantly higher rate of favorable functional outcome(50.2% vs 36.5%,p<0.001)and good collateral(grade of ASITN/SIRI: 2-3)(58.8% versus 43.2%,p<0.001),and lower median baseline National Institutes of Health Stroke Scale score(NIHSS)(15.6 versus 18.2,p<0.001),compared to patients with stroke of cardioembolism etiology.There was no significant difference in the rate of successful postprocedural mTICI between groups(84.5% versus 83.2%,p=0.671).Rates of symptomatic intracranial hemorrhage(20.0% versus 11.7%,p=0.004)and mortality(31.8% versus 18.8%,p<0.001)within 3 months were notably higher in the cardioembolism group than that in the LAA group.The multivariable analysis showed Older age,high baseline NIHSS score,poor recanalization after operation(mTICI:0-2a),hyperglycemia,times of thrombectomy > 3 and low preoperative ASPECTS score were independent risk factors for poor prognosis of EVT treatment in LAA group.Older age,high baseline NIHSS score,low preoperative ASPECTS score,poor recanalization after operation(mTICI:0-2a),poor collateral circulation and high NL ratio were independent risk factors for poor prognosis of EVT treatment in CE group.Conclusions: EVT may be more efficacious in treating acute ischemic stroke of LAA etiology than that of cardioembolism etiology.There are similarities and differences between LAA and CE groups in independent predictors for poor prognosis after EVT treatment.In clinical work,screening related risk factors for acute anterior circulation large artery occlusions srtoke patients with different etiology may improve the prognosis of EVT treatment.