Clinical Effectiveness and Safety Outcomes of Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke in China

Zi, Wenjie; Wang, Huaiming; Yang, Dong; Hao, Yonggang; Zhang, Meng; Yang, Geng; Lin, Min; Wan, Yue; Shi, Zhonghua; Zhou, Zhiming; Wang, Wei; Xu, Haowen; Tian, Xiaoxiao; Lv, Penghua; Wang, Shuiping; Liu, Wenhua; Wang, Zhen; Liu, Xintong; Guo, Feifei; Zheng, Dezhi; Li, Hua; Tu, Mingyi; Peng, Jin; Xiao, Guodong; Liu, Yuxiu; Xu, Gelin; Xiong, Yunyun; Liu, Xinfeng; Investigators, Actual

doi:10.1159/000478667

Cited by 59 publications

(44 citation statements)

References 38 publications

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“…We selected the patients from the multi-center EVT for acUte Anterior circuLation (ACTUAL) ischemic stroke registry from January 2014 to June 2016 [19]. Details of the ACTUAL registry were published previously [19].…”

Section: Methodsmentioning

confidence: 99%

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Neutrophil-Lymphocyte Ratio Predicts Functional and Safety Outcomes after Endovascular Treatment for Acute Ischemic Stroke

Duan

Wang

et al. 2018

Cerebrovasc Dis

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Background and Objective: Endovascular treatment (EVT) is proven to be safe and effective for treating acute large vessel occlusion stroke (LVOS). The neutrophil-lymphocyte ratio (NLR) reflects systemic inflammation, which plays an important role in the process of treating ischemic stroke. This study aims to explore the relationship between NLR and the clinical outcomes of LVOS patients undergoing EVT. Methods: Patients were selected from the EVT for acUte Anterior circuLation (ACTUAL) ischemic stroke registry. The laboratory data (neutrophil count, lymphocyte count) before EVT were collected. Poor functional outcome was defined as modified Rankin Scale (mRS) of 3–6 at 3 months. Multivariable logistic regression analyses were performed to explore the relationship of NLR with functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality. Results: We eventually included 616 patients (median of age, 66 years; 40.3% female). There were 350 (56.7%) patients achieving mRS of 3–6 at 3 months, 98 (15.9%) patients with sICH, and the mortality at 3 months was 24.8% (153/616). Baseline NLR was independently associated with poor functional outcome (OR 1.58; 95% CI 1.02–2.45; p = 0.039) and sICH (OR 1.84; 95% CI 1.09–3.11; p = 0.023) but showed a trend for predicting 3-month mortality (OR 1.57; 95% CI 0.94–2.65; p = 0.088). Conclusions: NLR independently predicts 3-month functional outcome and sICH but the existence of a trend association with mortality after EVT for acute anterior circulation LVOS patients.

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Section: Methodsmentioning

confidence: 99%

“…Details of the ACTUAL registry were published previously [19]. The registry retrospectively included acute ischemic stroke (AIS) patients with MRA/CTA/digital substraction angiography (DSA) confirmed anterior circulation large artery occlusion undergoing EVT in 21 centers in China.…”

Section: Methodsmentioning

confidence: 99%

Neutrophil-Lymphocyte Ratio Predicts Functional and Safety Outcomes after Endovascular Treatment for Acute Ischemic Stroke

Duan

Wang

et al. 2018

Cerebrovasc Dis

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“…Patients were included from the Endovascular Treatment for Acute Anterior Circulation (ACTUAL) [25] ischemic stroke registry, which enrolled acute ischemic stroke patients with anterior circulation large artery occlusion undergoing endovascular treatment from 21 stroke centers in China between January 2014 and June 2016. Details of ACTUAL registry were published previously [25].…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…Details of ACTUAL registry were published previously [25]. In brief, patients were programmed for endovascular treatment if they (1) were ≥18 years of age; (2) were diagnosed with acute anterior circulation stroke due to a largevessel occlusion verified by computed tomographic angiography, magnetic resonance angiography, digital-subtraction angiography; (3) had a National Institutes of Health Stroke Scale (NIHSS) scores > 5 at admission and premorbid modified Rankin Scale (mRS) scores < 2; and (6) could be treated within 6 h after onset of symptoms.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…Most of the large-artery occlusions in Caucasians are due to embolism from proximal sources, whereas intracranial atherosclerotic lesions with in situ thrombus occlusion are much more common in Asian patients [24]. The atherosclerotic occlusion is more difficult to be recanalized than cardiac embolism, which takes longer operative time and more rescue therapies [25]. As a result, the requirements for intraoperative anesthesia may be even higher, and the responses of general anesthesia and conscious sedation in Chinese thrombectomy patients have not been investigated yet.…”

Section: Introductionmentioning

confidence: 99%

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General Anesthesia may have Similar Outcomes with Conscious Sedation in Thrombectomy Patients with Acute Ischemic Stroke: A Real-World Registry in China

et al. 2018

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Background and Purpose: Clinical trials showed that anesthesia may not influence the functional outcome in stroke patients with endovascular therapy; however, data are lacking in China. Using real-world registry data, our study aims to compare the effects of general anesthesia or conscious sedation on functional outcomes in stroke patients treated with thrombectomy in China. Methods: Consecutive patients with acute anterior circulation stroke receiving thrombectomy in 21 stroke centers between January 2014 and June 2016 were included in this study. The propensity score analysis with 1: 1 ratio was used to match the baseline variables between patients with general anesthesia and the conscious sedation. The 90-day modified Rankin Scale (mRS), symptomatic intracranial hemorrhage (sICH), and death were compared between groups. Results: Of the 698 patients undergoing endovascular treatment, 138 were treated with general anesthesia and 560 with conscious sedation. After propensity score matching, 114 general anesthesia and 114 conscious sedation patients were matched. The proportions of patients with 90-day mRS 0–2 were not significantly different between general anesthesia and conscious sedation groups (41.2% [47/114] vs. 46.5% [53/114], p = 0.470), nor were the rates of sICH (21.9% [25/114] vs. 12.3% [14/114], p = 0.072) and 90-day mortality (31.6% [36/114] vs. 21.9% [25/114], p = 0.145). Conclusion: Anesthesia patterns may have no significant impacts on clinical outcomes in patients with acute anterior circulation occlusion stroke undergoing endovascular treatment in the real-world practice in China.

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Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke

Shan,

Pu,

et al. 2024

JAMA

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ImportanceIt is uncertain whether intravenous methylprednisolone improves outcomes for patients with acute ischemic stroke due to large-vessel occlusion (LVO) undergoing endovascular thrombectomy.ObjectiveTo assess the efficacy and adverse events of adjunctive intravenous low-dose methylprednisolone to endovascular thrombectomy for acute ischemic stroke secondary to LVO.Design, Setting, and ParticipantsThis investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 82 hospitals in China, enrolling 1680 patients with stroke and proximal intracranial LVO presenting within 24 hours of time last known to be well. Recruitment took place between February 9, 2022, and June 30, 2023, with a final follow-up on September 30, 2023.InterventionsEligible patients were randomly assigned to intravenous methylprednisolone (n = 839) at 2 mg/kg/d or placebo (n = 841) for 3 days adjunctive to endovascular thrombectomy.Main Outcomes and MeasuresThe primary efficacy outcome was disability level at 90 days as measured by the overall distribution of the modified Rankin Scale scores (range, 0 [no symptoms] to 6 [death]). The primary safety outcomes included mortality at 90 days and the incidence of symptomatic intracranial hemorrhage within 48 hours.ResultsAmong 1680 patients randomized (median age, 69 years; 727 female [43.3%]), 1673 (99.6%) completed the trial. The median 90-day modified Rankin Scale score was 3 (IQR, 1-5) in the methylprednisolone group vs 3 (IQR, 1-6) in the placebo group (adjusted generalized odds ratio for a lower level of disability, 1.10 [95% CI, 0.96-1.25]; P = .17). In the methylprednisolone group, there was a lower mortality rate (23.2% vs 28.5%; adjusted risk ratio, 0.84 [95% CI, 0.71-0.98]; P = .03) and a lower rate of symptomatic intracranial hemorrhage (8.6% vs 11.7%; adjusted risk ratio, 0.74 [95% CI, 0.55-0.99]; P = .04) compared with placebo.Conclusions and RelevanceAmong patients with acute ischemic stroke due to LVO undergoing endovascular thrombectomy, adjunctive methylprednisolone added to endovascular thrombectomy did not significantly improve the degree of overall disability.Trial RegistrationChiCTR.org.cn Identifier: ChiCTR2100051729

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Clinical Effectiveness and Safety Outcomes of Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke in China

Cited by 59 publications

References 38 publications

Neutrophil-Lymphocyte Ratio Predicts Functional and Safety Outcomes after Endovascular Treatment for Acute Ischemic Stroke

Neutrophil-Lymphocyte Ratio Predicts Functional and Safety Outcomes after Endovascular Treatment for Acute Ischemic Stroke

General Anesthesia may have Similar Outcomes with Conscious Sedation in Thrombectomy Patients with Acute Ischemic Stroke: A Real-World Registry in China

Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke

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