Endovascular Treatment in Acute Ischemic Stroke with Large Vessel Occlusion According to Different Stroke Subtypes: Data from ANGEL-ACT Registry

Xiaochuan Huo, Dapeng Sun, Raynald, Baixue Jia, Xu Tong, Anxin Wang, Ning Ma, Feng Gao, Dapeng Mo, Gaoting Ma, Sheyar Amin, Zeguang Ren, Zhongrong Miao, ANGEL-ACT study group, Xiaochuan Huo, Dapeng Sun, Raynald, Baixue Jia, Xu Tong, Anxin Wang, Ning Ma, Feng Gao, Dapeng Mo, Gaoting Ma, Sheyar Amin, Zeguang Ren, Zhongrong Miao, ANGEL-ACT study group

Abstract

Introduction: Endovascular treatment's (EVT) safety and efficacy have been proven in treating acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, limited data exist in different stroke subtypes. We aimed to investigate the differences in efficacy and safety of EVT for acute LVO according to different stroke subtypes.

Methods: A total of 1635 AIS patients with LVO undergoing EVT from a prospective cohort of the Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) registry were classified into three types according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. We compared the primary outcome: 90-day modified Rankin Scale (mRS) score, the secondary outcomes: 90-day mRS (0-1, 0-2, and 0-3), successful recanalization (mTICI 2b/3), and complete recanalization (mTICI 3), and the safety outcomes: death within 90 days, parenchymal hemorrhage (PH), and symptomatic intracranial hemorrhage (SICH) among the three subtypes of stroke patients. Then, multivariable logistic regression models adjusting for potential baseline-confounding variables to determine the associations between stroke subtypes and safety and efficacy endpoints were performed. Finally, we performed subgroup analyses to explore discrepancies in the relationships.

Results: EVT of cardioembolic LVO (CE-LVO) had a higher rate of mTICI 3 (71.7% vs. 65.9% and 63.2%; P = 0.024) and a higher rate of PH (13.8% vs. 5.4% and 6.7%; P < 0.001) when compared to other stroke subtypes. Even multivariable analysis demonstrated that CE-LVO was associated with mTICI 3 [adjusted odds ratio (OR), 1.50 (95% CI 1.04-2.17)] and PH [adjusted OR, 1.97 (95% CI 1.09-3.55)]. However, the 90-day mRS distribution and 90-day mRS (0-1, 0-2, and 0-3) did not differ among the stroke subtypes, and nor did the SICH (P > 0.05).

Conclusions: Functional outcomes were similar among different stroke subtypes. Despite a higher rate of complete recanalization, there is an increased risk of parenchymal hemorrhage in CE-LVO.

Trial registration: Clinical trial registration number: NCT03370939.

Keywords: Efficacy; Endovascular treatment; Outcomes; Safety; TOAST classification.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart of patient selection. EVT endovascular treatment, SAA small-artery occlusion lacunar, LAA large-artery atherosclerosis, CE cardioembolism, SUE/SOE stroke of unknown etiology/stroke of other determined etiology, LVO large vessel occlusion
Fig. 2
Fig. 2
Shift on 90-day mRS score stratified by TOAST classification. LAA large-artery atherosclerosis, CE cardioembolism, SUE/SOE stroke of unknown etiology/stroke of other determined etiology, LVO large vessel occlusion, mRS modified Rankin Scale

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