Mechanical endovascular recanalization therapy for over-time-window acute ischemic stroke: initial experience in 11 cases

Objective: To evaluate the safety and efficacy of imaging-guided mechanical endovascular recanalization therapy in treating patients with over-time-window acute ischemic stroke. Methods: A total of 91 consecutive patients with acute ischemic stoke, who were admitted to authors' hospital during the period from March 2013 to October 2014 to receive mechanical endovascular recanalization therapy, were collected, among them over-time-window acute ischemic stroke and ischemic penumbra demonstrated on imaging examination were seen in 11 patients, including 9 males and 2 females with a median age of 59 years. Before endovascular recanalization therapy and 30 days after the treatment, NIHSS score changes were determined, and the clinical outcome was evaluated with modified Rankin scale (mRS) at 90 days after the treatment. Results: In the 11 patients, mechanical endovascular recanalization was carried out for 4 middle cerebral arteries, 3 internal carotid arteries and 4 vertebral basilar arteries, the therapeutic methods included stent angioplasty (n = 10) and mechanical thromboectomy combined with stent angioplasty (n = 1). The recanalization rate was 90.9% (10/11). Re-occlusion rate within 30 days after management was 9.1% (1/11). The median NIHSS score determined at 90 days after management was 4 points (0-12 points), which was significantly (P < 0.05) better than preoperative 11 points (4-35 points). Before treatment the number of patients with mRS 0-2 points was zero, and the number of patients with mRS 0-2 points increased to 7 (63.6%, 7/11) at 90 days after the treatment. Conclusion: For the treatment of over-time-window acute ischemic stroke, imaging-guided mechanical endovascular recanalization therapy is safe and effective. (authors)