Study Evaluates Relation of Cerebral Occlusion Sites to Endovascular Treatment Outcomes
November 8, 2017—Findings from an analysis of the chances of a good outcome in the treatment of cerebral occlusion with respect to the distance to thrombus (DT) in patients treated endovascularly versus intravenously were recently published by Benjamin Friedrich, MD, et al online ahead of print in CardioVascular and Interventional Radiology (CVIR).
As explained in CVIR, the background of the study is that endovascular thrombectomy has become the de facto standard in the treatment of large vessel occlusion. Previously, a correlation between good outcome and the occlusion site, measured by the DT (the distance from the carotid T to the beginning of the thrombus) after thrombolysis, could be shown.
The present study is a dual-center database analysis that included patients with stroke caused by occlusion of the middle cerebral artery (MCA). The inclusion criteria were a completed treatment and full documentation of the clinical course. DT was measured in pretreatment images and was correlated with the modified Rankin scale at 90 days and stratified according to the different treatment methods.
The investigators reported that 280 patients could be included in the analysis, which showed a correlation between the chances of good clinical outcome and the occlusion site measured by DT after intravenous thrombolysis. The outcome after endovascular treatment showed no correlation with DT (P = .227). After a DT of 26 mm, the chances of a good outcome after intravenous thrombolysis exceeded those after endovascular treatment.
The investigators concluded that in patients with MCA occlusion, the probability for a good outcome after endovascular treatment is independent of the occlusion site in contrast to treatment with intravenous thrombolysis. If the occlusion occurred in the periphery of the M2 region (DT > 26 mm), intravenous thrombolysis alone was superior to endovascular treatment in achieving a good outcome, advised the investigators in CVIR.