Success rates of revascularization methods in ischemic stroke in clinical practice

Objective. To compare the success rates of various revascularization methods in patients presenting with ischemic stroke (IS) in a real-world practice. Material and methods. An open-label prospective observational study was conducted involving 225 patients diagnosed with IS. The patients were categorized into three distinct groups: Group 1 (67.1% of participants) received systemic thrombolytic therapy [TLT], Group 2 (15.6% of participants) received intravascular thrombectomy (IVTE), and Group 3 (17.3% of participants) received combined TLT+IVTE, referred to as bridge therapy. The assessment of neurological status was conducted using the National Institutes of Health Stroke Scale (NIHSS), functional activity was evaluated according to the modified Rankin Scale (mRs), mobility was measured based on the Rivermead Mobility Index (RMI), and the completeness of perfusion recovery was determined using the Thrombolysis in Cerebral Infarction (TICI) classification for Groups 2 and 3. Functional recovery was evaluated after 6 months using the Barthel Index (BI). Results. Demographic characteristics across the groups were comparable. Statistically significant differences in the timing of revascularization were observed: Groups 1 and 3 received treatment within approximately 2.5 hours, whereas Group 2 received treatment within 6 hours. Baseline stroke severity, as measured by the NIHSS, was significantly higher in Groups 2 and 3 (p<0.002). The TICI scores of 2b-3 were noted in 74.3% of patients in Group 2 and 79.5% in Group 3, reflecting the substantial technical success rates of endovascular interventions. At discharge, patients in Group 1 exhibited the greatest reduction in neurological deficit (p=0.011). Independence in daily activities (rated 0—2 on the mRs) was achieved by 28.5% of patients in Group 1, 8.6% in Group 2, and 12.8% in Group 3. The mortality rate over 6 months was 24.5% in Group 1, 51.4% in Group 2, and 33.3% in Group 3 (p=0.002 between Groups 1 and 2). The BI at the six-month mark was significantly higher in Group 1 (90 [60; 100]) compared to Groups 2 (60 [50; 85]) and 3 (65 [50; 97.5]). Conclusions. The findings suggest that systemic TLT, particularly in patients with less severe strokes and timely treatment initiation, is associated with the most favorable outcomes. In contrast, IVTE and combination therapy (bridge therapy) administered to patients with NIHSS scores exceeding 10 and/or large vessel occlusions demonstrate comparable technical success rates but yield less favorable clinical outcomes. Critical determinants influencing outcomes include the duration from symptom onset to intervention and baseline stroke severity.