Manabu Shirakawa1, Hidetoshi Matsukawa1, Nobuyuki Sakai2, Hiroshi Yamagami3, Kanta Tanaka4, Hirotoshi Imamura2, Yasushi Matsumoto5, Masataka Takeuchi6, Hiroto Kageyama1, Kazutaka Uchida7, Takeshi Morimoto8, Shinichi Yoshimura1. 1. Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan. 2. Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan. 3. Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan. 4. Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan. 5. Department of Neuroendovascular Therapy, Kohnan Hospital, Miyagi, Japan. 6. Department of Neurosurgery, Seishou Hospital, Odawara, Japan. 7. Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan. 8. Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
Abstract
OBJECTIVES: Endovascular therapy (EVT) is safe and effective for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). However, the influence of the AIS subtype (large-artery atherosclerosis [LAA] or cardioembolism [CE]) on clinical outcome in patients treated with EVT remains unclear. This study aimed to evaluate the differences in clinical results between the two subtypes using data from a multicenter prospective registry (RESCUE-Japan Registry 2). MATERIALS AND METHODS: Among 2420 patients in RESCUE-Japan Registry, 682 patients who were diagnosed with LAA or CE were enrolled. The primary outcome was a modified Rankin Scale (mRS) score of 0-2 at 90 days. The secondary outcomes were 90-day mRS 0-1, 0-3, and 6. The relationship between time from onset and clinical outcome was also analyzed. RESULTS: Among the 682 patients, 124 were classified into the LAA group and 558 into the CE group. The baseline National Institutes of Health Stroke Scale score was significantly lower (median 15 vs. 18, p < 0.001). At 90 days, mRS 0-2 was observed in 54 of 124 patients (44%) in the LAA group and 232 of 558 patients (42%) in the CE group (p = 0.69). The proportion of patients with mRS 0-2 tended to decrease according to onset-to-puncture time in the CE group but not in the LAA group (ptrend=0.0007). CONCLUSIONS: The rate of good outcome was similar between LVO due to LAA and CE. However, the rate of favorable outcome did not decrease according to onset-to-puncture time in the LAA group.
OBJECTIVES: Endovascular therapy (EVT) is safe and effective for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). However, the influence of the AIS subtype (large-artery atherosclerosis [LAA] or cardioembolism [CE]) on clinical outcome in patients treated with EVT remains unclear. This study aimed to evaluate the differences in clinical results between the two subtypes using data from a multicenter prospective registry (RESCUE-Japan Registry 2). MATERIALS AND METHODS: Among 2420 patients in RESCUE-Japan Registry, 682 patients who were diagnosed with LAA or CE were enrolled. The primary outcome was a modified Rankin Scale (mRS) score of 0-2 at 90 days. The secondary outcomes were 90-day mRS 0-1, 0-3, and 6. The relationship between time from onset and clinical outcome was also analyzed. RESULTS: Among the 682 patients, 124 were classified into the LAA group and 558 into the CE group. The baseline National Institutes of Health Stroke Scale score was significantly lower (median 15 vs. 18, p < 0.001). At 90 days, mRS 0-2 was observed in 54 of 124 patients (44%) in the LAA group and 232 of 558 patients (42%) in the CE group (p = 0.69). The proportion of patients with mRS 0-2 tended to decrease according to onset-to-puncture time in the CE group but not in the LAA group (ptrend=0.0007). CONCLUSIONS: The rate of good outcome was similar between LVO due to LAA and CE. However, the rate of favorable outcome did not decrease according to onset-to-puncture time in the LAA group.