Long⁃term prognosis of endovascular treatment in patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window

Abstract

Objective To evaluate the long⁃term prognosis in patients with acute ischemic strokedue to large vessel occlusion presenting beyond the conventional time window (> 24 h) who receivedendovascular treatment (EVT) combined with best medical treatment (BMT), compared to those treated withBMT alone. Methods This study included 158 patients from a prospective cohort of acute ischemic strokedue to large vessel occlusion were conducted at Tianjin Huanhu Hospital from November 2021 to July2023. The 158 patients with anterior circulation large vessel occlusion were divided into received EVTcombined with BMT (EVT group, n = 70) and received BMT alone (BMT group, n = 88). Long ⁃ termneurological prognosis was assessed using the modified Rankin Scale (mRS) 12 months after onset.Univariate and multivariate stepwise Logistic regression analyses were useded to investigated the risk factorsof long⁃term neurological prognosis. Sensitivity analyses were performed using propensity score matching(PSM) and multiple imputation (MI). Results Logistic regression analysis showed that EVT was aprotective factor for good long ⁃term neurological prognosis (mRS score ≤ 2; OR = 3.110, 95%CI: 1.460-6.620, P = 0.003), increasing age (OR = 0.955, 95%CI: 0.924-0.987; P = 0.007) and hypertension (OR =0.418, 95%CI: 0.187-0.936; P = 0.034) were risk factors. In the sensitivity analyses of the primary outcome, both the PSM and MI datasets showed that the proportion of patients with a good long ⁃ termneurological prognosis was significantly higher in the EVT group compared to the BMT group (PSM: aOR =3.610, 95%CI: 1.370-9.550, P = 0.010; MI: aOR = 3.870, 95%CI: 1.780-8.440, P = 0.000). The resultswere consistent with the main analysis. Conclusions Compared to BMT group, EVT group patients withacute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window wasdemonstrated a significantly better long⁃term neurological prognosis.

doi：10.3969/j.issn.1672⁃6731.2024.11.010