Primary Endovascular Thrombectomy in Acute Ischemic Stroke in Patients Ineligible for Intravenous Thrombolysis

Endovascular treatment (EVT) of acute ischemic stroke (AIS) is the main treatment of large vessel occlusion (LVO). Nonetheless, access to EVT is limited specially in developing countries. It is not uncommon in these regions to miss the time window for intravenous thrombolysis (IVT) or to arrive within the IVT window but with a contraindication for it. Hence, a lot of patients with LVO face a situation where either they receive EVT only or conservative management according to available logistics.

Aim: To study the outcome of EVT vs best medical treatment (BMT) in two Egyptian stroke centres (Tanta and Alexandria) in AIS patients ineligible for IVT.

Results: 390 patients with AIS and LVO were included in the study. 74 underwent EVT while 316 underwent BMT. There were no statistical differences in age, sex, time of onset, initial severity, or imaging scores in both groups. The EVT group had more diabetes mellitus (DM) patients, more smokers and more systolic and diastolic blood pressure (BP) while the BMT had more anticoagulated patients. The EVT group had better functional outcome but more symptomatic intracerebral haemorrhage with no difference in mortality.

Conclusion: Endovascular treatment doubles the good functional outcome of AIS in LVO patients but ICH is more with no effect on mortality.