Outcomes of patients with acute large anterior circulation vessel occlusion

Patients experiencing acute ischemic stroke due to large vessel occlusion (LVO) often face unfavorable outcomes. Mechanical thrombectomy (MT) is recommended for suitable candidates. This study aimed to assess the outcomes of patients with acute anterior circulation LVO by comparing data from before and after the implementation of MT, as well as identifying predictors of favorable outcomes in these patients. Materials and methods : Patients with acute ischemic stroke from anterior circulation large vessel occlusion during July, 2018–January, 2022 were studied. Baseline characteristics and the outcomes at 3 months were compared among different interventions. Predictors of favorable outcomes were analyzed. 205 patients, with a mean NIHSS of 16, were included. Intravenous alteplase was administered to 142 (69 %), while 103 patients (50 %) underwent MT. At 3 months, favorable outcomes (mRS0-2) were observed in 17 % of patients without reperfusion treatment, 39 % of those receiving intravenous alteplase, 55 % of those treated with a combination of intravenous thrombolysis and MT, and 50 % of patients who had MT alone. Multivariate analysis identified several factors linked to favorable outcomes: mechanical thrombectomy (OR 2.779, 95 %CI 1.081–7.057, p -value = 0.034), MCA occlusion (OR 5.88, 95 %CI 2.02–17.24, p -value = 0.001), ASPECTS 7–10 (OR 2.98, 95 %CI 1.01–8.85, p -value = 0.048), age under 70 years (OR 2.89, 95 %CI 1.03–8.13, p -value = 0.044) and NIHSS scores below 15 (OR 4.17, 95 %CI 1.62–10.75, p -value = 0.003). Conclusions : Without reperfusion treatment, patients with LVO had poor outcomes. Mechanical thrombectomy improved recanalization rates, resulting in better favorable outcomes and reduced mortality, while not significantly increasing the risk of symptomatic intracranial hemorrhage.