Recanalization Following Various Endovascular Modalities for Treatment of Anterior Circulation Acute Ischemic Strokes

Abstract

Currently several endovascular modalities and devices are available for use in acute ischemic stroke setting.
Limited data exist regarding the relative efficacy of these different options when used individually or in
combination. The primary objective of this study was to retrospectively compare the recanalization rates of
various endovascular options when used for the treatment of acute ischemic stroke in the anterior cerebral
circulation. We retrospectively reviewed 132 consecutive patients treated endovascularly at our center for
acute ischemic stroke in the anterior cerebral circulation. Recanalization was defined as mTIMI of ≥ 2
while complete recanalization was defined as mTIMI of 4. Statistical analysis was performed to determine
the modality or combination of modalities associated with best recanalization rate. Recanalization was achieved in 74% of patients while complete recanalization was achieved in 39% of patients. No individual
endovascular therapy was significantly different from others in achieving recanalization. Where a multimodality approach was used, combination of angioplasty with intra- or extracranial stent placement was significantly (p=0.05) associated with recanalization. On regression analysis, combination of intra-arterial tPA
with a mechanical modality (p=0.09) was significantly associated with recanalization while combination of
intravenous tPA with intracranial stent placement (p=0.06) was significantly associated with complete
recanalization. Combination of pharmacological and mechanical modalities in the setting of multimodal
therapy is associated with increased likelihood of successful recanalization in patients with acute ischemic
stroke in the anterior cerebral circulation. Stent placement in acute stroke setting is promising and needs
further exploration. Further prospective studies are needed.