Clinical effect analysis of recanalization treatment for acute ischemic stroke with large infarct core caused by intracranial atherosclerotic stenosis and cardiac embolism

Objective To investigate the short ⁃ term efficacy, long ⁃ term outcome and safety of recanalization treatment in patients with acute ischemic stroke presenting with large infarct core caused by intracranial atherosclerotic stenosis (ICAS) versus cardiac embolism (CE). Methods A total of 96 acute ischemic stroke patients with large infarct core who underwent recanalization treatment at The People's Hospital of Anyang City from January 2022 to January 2023 were enrolled. Based on etiology, patients were divided into ICAS group (n = 52) and CE group (n = 44). Short⁃term efficacy was assessed using the National Institutes of Health Stroke Scale (NIHSS) at 14 d postoperatively, while long⁃term outcome was evaluated using the modified Rankin Scale (mRS) at 90 d postoperatively. Safety outcome included rate of symptomatic intracranial hemorrhage (sICH), intracranial hemorrhage, cerebral herniation within 24 h postoperatively, and fatality rate at 90 d postoperatively. Results A statistically significant difference in NIHSS score was observed between the ICAS group and the CE group (F=5.821, P=0.023), with the CE group having higher NIHSS score than the ICAS group at admission (t=⁃2.324, P=0.022). Both groups showed significant differences in NIHSS score between admission and 14 d postoperatively (F=589.322, P =0.000), with the CE group demonstrating lower NIHSS score at 14 d postoperatively compared to admission (t=4.173, P=0.001). The ICAS group exhibited a higher rate of favorable outcome at 90 d postoperatively [44.23% (23/52) vs. 25% (11/44); χ2 =3.853, P=0.050]. No significant differences were observed between the 2 groups in sICH, intracranial hemorrhage, cerebral herniation rate, or 90 d fatality rate (P > 0.05, for all). Conclusions Recanalization treatment for acute ischemic stroke patients with large infarct core caused by CE demonstrates more pronounced short⁃term efficacy, while ICAS presenting with better long⁃term outcome, and there is no significant difference in safety between the 2 groups.