Clinical outcome after mechanical recanalization as mono- or adjunctive therapy in acute stroke: importance of time to recanalization.

BACKGROUND: The clinical benefit of mechanical recanalization procedures for acute stroke is still a matter of debate. We report the clinical and imaging results of 34 consecutive patients, focusing on time aspects (i.e. vessel occlusion time and procedure duration).
METHODS: During a 3-year period, 34 stroke patients with large-vessel occlusion (anterior circulation, n = 19; posterior circulation, n = 15) were treated with several mechanical recanalization devices with (n = 17) or without prior intravenous thrombolysis. Clinical and imaging data before (NIHSS) and after treatment [(mRS) 3 and 6-30 months] were analyzed. The angiographic outcome (TIMI score), complication rates, and procedural issues (i.e. procedure duration and vessel occlusion time) were assessed.
RESULTS: The median NIHSS on admission was 17. Successful recanalization (TIMI 2 and 3) was achieved in 23 (68%) patients. The median time from symptom onset to recanalization was 330 min, and the median time from angiography to recanalization was 101 min. Six (18%) patients had a good clinical outcome (3-month mRS ≤2), and 10 (29%) died. The vessel occlusion time was significantly shorter in patients with a good compared to poor clinical outcome (247 vs. 348 min, p = 0.024). In the subgroup of anterior circulation stroke, successful recanalization, and no symptomatic intracranial hemorrhage (n = 11), there was a strong correlation between vessel occlusion time and clinical outcome (r = 0.711, p = 0.014).
CONCLUSIONS: The rate of vessel recanalization with endovascular therapy is promising. Nevertheless, the long-term clinical outcome is still disadvantageous in the majority of patients, presumably due to too long vessel occlusion times. Better strategies for patient selection and optimization of recanalization strategies (i.e. shorter time intervals to vessel patency) are warranted.