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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(03): 462-471
DOI: 10.1055/s-0044-1787984
Original Article

Insights into Angiographic Recanalization of Large Arterial Occlusion: Institutional Experience with Mechanical Thrombectomy for Acute Ischemic Stroke

Bheru Dan Charan 
1   Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
,
Shailesh B. Gaikwad
1   Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
,
Savyasachi Jain
1   Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
,
Ajay Garg
1   Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
,
Leve Joseph Devarajan Sebastian
1   Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
,
M. V. Padma Srivastava
2   Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
,
Rohit Bhatia
2   Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
,
Awadh Kishore Pandit
2   Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
,
Shashank Sharad Kale
3   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations Funding None.
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Abstract

Stroke is a leading cause of morbidity and mortality in humans. Most strokes are ischemic in nature and early recanalization of occluded vessels determines good outcomes. Recanalization of occluded vessels depends on many angiographic and demographic features. These factors need to be identified for better patient overall outcomes. Better preoperative knowledge of factors can help in customizing our treatment approach and explaining the prognosis to the guardians of the patients. We aim to share our institutional experience with mechanical thrombectomy (MT) for stroke and studied factors that affect an angiographic recanalization of vessels. A retrospective single-center study was conducted involving 104 patients who underwent MT at our institution between January 2016 and December 2019. Patient demographics, baseline characteristics, pre- and postprocedural imaging findings, and other clinical data were meticulously reviewed. We divided patients into successful recanalization (modified thrombolysis in cerebral ischemia [mTICI] 2b or 3) and unsuccessful recanalization (mTICI 2a or 1) groups and various factors were analyzed to evaluate their impact on recanalization rates. In the univariate analysis, a significant association was observed between successful recanalization and several factors: the absence of rheumatic heart disease (RHD) as a risk factor (p = 0.035), the presence of a hyperdense vessel sign (p = 0.003), and the use of treatment methods including aspiration (p = 0.031), stent retriever (p = 0.001), and Solumbra (p = 0.019). However, in the multivariate analysis, none of these factors exhibited statistical significance. The presence of RHD is a risk factor associated with poor angiographic recanalization in all three MT treatment modalities. Based on the above variables we can guide the patients/relatives prior to MT procedure for their better outcome and risk–benefit ratio.

Keywords

mechanical thrombectomy - stroke - recanalization

Authors' Contributions

B.D.C., S.B.G., S.J., A.G., and L.J.D.S. contributed to the acquisition, analysis, conception, design, and drafting of the work. M.V.P.S., R.B., A.K.P., S.S.K., B.D.C., S.B.G., S.J., A.G., and L.J.D.S. contributed to the final draft, revisions, upload, and submission of final revised work. All authors have agreed to be personally accountable for their contributions and ensured that questions related to the accuracy or integrity of any part of the work, even those in which one was not personally involved, are appropriately investigated, resolved, and documented in the literature.


Ethical Approval

This work has been approved by the Institute Ethical Committee (IEC).




Publication History

Article published online:
25 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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