Outcomes Of Endovascular Treatment For Ischemic Stroke Due To Large Artery Occlusion In Anterior Circulation With Etiology Of Large Artery Atherosclerosis Or Cardioembolism

Background: Mechanical thrombectomy is emerging as the main treatment for acute ischemic stroke(AIS)due to large artery occlusion(LVO)in anterior circulation.However,LVO with underlying atherosclerotic stenosis may be more difficult to be recanalized with stent-like retrievers.Even after successful recanalization,atherosclerotic occlusions may be more likely to reocclude due to in situ thrombosis.In general,rescue therapy such as angioplasty and low-dose intra-arterial tirofiban infusion are often needed.Whether the multimodal endovascular treatment is safe and effective in the Chinese population with a high incidence of atherosclerosis remains unproved.Objective:To investigate the safety and efficacy of mechanical thrombectomy for intracranial LVO with etiology of large artery atherosclerosis(LAA)or cardioembolism(CE).Methods: A retrospective review of patients with AIS of the anterior circulation who underwent endovascular treatment for LVO.Patients were assigned to LAA group and CE group primarily based on etiology.Procedural and clinical outcomes were compared between two groups.According to the modified Rankin scale score(m RS)at 90 days,a favorable outcome was defined as a m RS score of 0-2.Multivariate logistic regression was performed to determine independent predictors of functional independence at 90 days and symptomatic intracranial hemorrhage(s ICH).Result: A total of 283 patients were enrolled,including 71 patients in the LAA group and 112 patients in the CE group.Recanalization rate(83.1% vs.83.9%,P=0.883)and functional independence at 3 days(46.5% vs.43.8%,P=0.718)were comparable between the LAA group and CE group.Compared to patients in CE group,the patients in LAA group had significantly higher rate of favorable functional outcome(49.3% vs.25.0%,P=0.001).No significant difference in s ICH(15.5%vs.18.8%,P=0.572)or mortality(14.1% vs.22.3%,P=0.167)was found between the two groups.Multivariate regression analysis showed that the etiology of LAA was independently associated with functional independence at 90 days(OR=0.416,95%CI=0.198-0.873,P=0.020).In the LAA group,fasting glucose(OR=0.711,95%CI=0.539-0.940,P=0.017)and recanalization rate(OR=0.052,95%CI=0.006-0.442,P=0.007)were independent predictor of functional independence at 90 days.In addition,in the LAA group,only National Institutes of Health Stroke Scale(NIHSS)score at presentation independently associated with functional independence at 90 days(OR=0.815,95%CI=0.729-0.912,P<0.001),and collateral circulation was associated with the incidence of s ICH(P<0.05).Conclusion: Multimodal endovascular treatment for AIS with etiology of LAA for LVO may be more efficacious than that of CE etiology.For patients with the etiology of LAA,successful recanalization predicts favorable functional outcome.Good collateral circulation is more efficacious in reducing the incidence of s ICH in patients with CE etiology.