Four-year Experience of Intravenous and Endovascular Treatment in Acute Ischemic Stroke: A Single Center Study

Zeynep Özdemir1, Gülşah Zorgör Dindar2, Sena Aksoy1, Erkan Acar3, Hakan Selcuk4, Batuhan Kara4, Aysun Soysal1

1Istanbul Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Clinic of Neurology, Istanbul, Turkey
2University of Health Sciences Turkey, Basaksehir Cam and Sakura City Hospital, Clinic of Neurology, Istanbul, Turkey
3Acibadem Mehmet Ali Aydinlar University Faculty of Medicine, Department of Neurology, Istanbul, Turkey
4University of Health Sciences Turkey, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Clinic of Radiology, Istanbul, Turkey

Keywords: Acute stroke, acute stroke treatment, iv tPA, endovascular treatment

Abstract

Objective: Acute ischemic stroke (AIS) is a major cause of mortality and morbidity throughout the world. Intravenous thrombolysis (IVT) and endovasculary treatments (EVT) are recomended currently in eligible patients admitted within the therapeutic window. In this study, the data of AIS patients who were treated with intravenous and EVT methods in Istanbul Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital between 2017-2020 were evaluated retrospectively

Materials and Methods: Five hundred and ninety patients who received IVT and/or EVT were included in the study. Demographic, clinical, radiological characteristics, risk factors and post-treatment clinical characteristics of these patients were analyzed.

Results: Of the 590 patients, 324 (54.9%) underwent IVT, 164 (27.8%) EVT and 102 (17.3%) combined IVT+EVT. The median National Institutes of Health Stroke Scale (NIHSS) scores were 9 (1-21) in the iv tPA group, 13 (3-27) in the EVT group, 12 (4-23) in the combined treatment group at admission In the IVT group, 220 patients had no artery occlusion (67.9%), M2 segment of the middle cerebral artery (MCA) was found to be the most frequently occluded artery with 32 patients (9.9%). In the EVT and combined IVT+EVT groups, the M1 segment of the MCA had the highest occlusion rate [76 (44.2%), 49 (45%), respectively]. Asymptomatic hemorrhage rate was higher in the EVT group than the other groups. Symptomatic hemorrhage rate was lower in the IVT group compared to the other groups. A total of 182 (56.2%), 67 (39%) and 53 (48.6%) patients in the IVT, EVT and combined IVT+EVT groups had good outcome, respectively.

Conclusion: Acute stroke treatment has been proven to significantly reduce the serious burden of stroke on patients, caregivers and society. For this reason, the societal awareness of the importance of urgent admission to emergency departmentsand the number and capacity of centers that provide AIS treatments should be increased.

Ethics Committee Approval

The ethics committee approval was obtained from the Ethics Committee of the Clinical Studies Ethics Committee of University of Health Sciences Turkey, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, with the number of 2021/246.

Peer Review

Externally peer-reviewed.

Author Contributions

Surgical and Medical Practices: Z.Ö., G.Z.D., S.A., E.A., H.S., B.K., Concept: Z.Ö., S.A., A.S., Design: Z.Ö., A.S., Data Collection or Processing: Z.Ö., G.Z.D., S.A., Analysis or Interpretation: Z.Ö., S.A., E.A., A.S., Literature Search: Z.Ö., Writing: Z.Ö., E.A.

Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

The authors declared that this study received no financial support.