Stent Retriever Thrombectomy In Patients With Acute Ischemic Stroke And Multiple Contraindications For Intravenous Thrombolysis:a Case-control Study

Objective:Intravenous thrombolysis is the standard of care for patients with acute ischemic stroke within 4.5 hours time window after symptom onset.However,the majority of patients are ineligible for intravenous thrombolysis due to various contraindications.Now,evidences have prove that mechanical thrombectomy in combination with intravenous thrombolysis can make patients with large-vessel occlusion benefit.The purpose of this paper is to analyse the safety and effectiveness in patients with stent retriever thrombectomy compared with conventional drug treatment by means of neurological scales,so as to explore the application value of only stent retriever thrombectomy in patients with acute ischemic stroke and multiple contraindications for intravenous thrombolysis.Methods:Patients from Taiyuan city central hospital,Shanxi province people’s hospital or the Chinese People’s Liberation Army 264 th hospital with acute ischemic stroke were selected from January 2016 to January 2017.Inclusion criteria were the following: acute stroke due to proved large-artery occlusion,ineligibility for intravenous thrombolysis,a timeframe of 6 hours between stroke and stent retriever thrombectomy or conventional drug treatment.All the subjects underwent stent retriever thrombectomy or conventional drug treatment.Before and after treatment,neurological scale assessment were evaluated,including the modified Rankin scale(mRS),the United States national institutes of health stroke scale(NIHSS)scores,Recanalization success,mortality,and hemorrhages were analyzed.Results:A total of 43 patients were included.23 patients received stent retriever thrombectomy,and 20 patients received conventional drug treatment.Compared to patients in conventional drug treatment group,patients in stent retiever thrombectomy group were younger(58.70±13.23 vs 69.2±11.54,P=0.009),and more often females(65.22% vs 30%,P=0.021).The occlusion locations in patients in stent retiever thrombectomy group were the following: carotid artery in 1,intenal carotid artery in 6,middle cerebral artery M1 segment in 12,middle cerebral artery M2 segment in 2,vertebral artery in 1,and basilar artery in 1.The 72-hours average NIHSS score after treatment in stent retiever thrombectomy group was 10(8.5),which was not only lower than 72-hours average NIHSS score after treatment in conventional drug treatment group(P=0.043),but also lower than average NIHSS score before the treatment in stent retiever thrombectomy group(P<0.0001).More patients in stent retiever thrombectomy group achieved higher rates of a score of 0 to 2 on the mRS scale at 90 days after treatment(47.83%vs5%,P=0.002).The rates of successful recanalization(Thrombolusis in Cerebral Infarction 2b/3)was increased with the stent retiever thrombectomy(86.96%vs5%,P=0.001).There were no significant differences in rates of death(8.7% v15%,P=0.52)or symptomatic intracerebral hemorrhage(0% v15%,P=0.054)in both groups.Conclusion:1.In patients with acute ischemic stroke with a proximal cerebral arterial occlusion and multiple contraindications for intravenous thrombolysis,stent retiever thrombectomy,as compared with conventional drug treatment,decreased the 72-hours average NIHSS score and improved early neurologic recovery.2.In patients with acute ischemic stroke with a proximal cerebral arterial occlusion and multiple contraindications for intravenous thrombolysis,stent retiever thrombectomy,as compared with conventional drug treatment,increased rates of a score of 0 to 2 on the mRS scale at 90 days after treatment and increased the rate of functional independence.3.In patients with acute ischemic stroke with a proximal cerebral arterial occlusion and multiple contraindications for intravenous thrombolysis,stent retiever thrombectomy,ascompared with conventional drug treatment,did not reduce mortality or the rates of symptomatic intracerebral hemorrhage at 90 days after treatment.