Since intravenous thrombolysis (IVT) is often associated with poor outcomes in hypertensive patients with severe acute cerebral infarction (ACI) due to occlusions of the internal carotid, basilar, or proximal middle cerebral artery, we evaluated whether multimodal intra-arterial treatment (IAT) might improve functional outcomes in this patient population. We retrospectively reviewed the charts of eligible patients who underwent multimodal IAT including intra-arterial thrombolysis, mechanical thrombectomy, balloon and/or stent angioplasty (IAT group) or IVT alone (IVT group). Outcomes included the revascularization rate 24 hours postprocedure, the frequency of survival at 7, 90, and 180 days postonset, and a measure of functional outcomes using the modified Rankin Scale (mRS). The IAT group included 62 patients and the IVT group included 31 patients. Multimodal IAT increased the revascularization rate at 24 hours (p<0.001) and the frequency of survival and functional independence (mRS ≤2) at 7 days (p<0.001 and p=0.018, respectively), 90 days (both p<0.001), and 180 days (both p<0.001). Independent predictors of longer survival were treatment with multimodal IAT (HR 0.1; 95% CI 0.0 to 0.4; p<0.001) and revascularization (HR 0.1; 95% CI 0.0 to 0.4; p<0.001), whereas a longer duration from onset to treatment was a risk factor for death (HR 1.4; 95% CI 1.2 to 1.8; p<0.001). There was no significant between-group difference for symptomatic hemorrhagic transformation. This study found that for patients with severe hypertensive ACI with large vessel occlusions, multimodal IAT improved the outcomes, including early revascularization, survival, and functional outcome.
- intra-arterial treatment
- intravenous thrombolysis
- large vessel occlusion
- acute cerebral infarction
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Contributors We declare that all the listed authors have participated actively in the study and all meet the requirements of the authorship. ZT designed the study and wrote the protocol. GL, ZT, LL and CC performed research/study. ZT, SL and GL contributed important cases (reagents). ZT, GL, SL and YL managed the literature searches and analyses. ZT and SL undertook the statistical analysis. ZT and YS wrote the first draft of the manuscript. ZT, GL, YL and CC collected data. ZT and YS obtained funding. ZT, GL and SL took overall responsibility. ZT and YS contributed the funding of the manuscript.
Funding This work was supported by grants from the Guangzhou City Science and Technology Foundation (201510010181), the Guangdong Province Science and Technology Foundation (2013B021800282, 2014A020212350 and 2014A020212364) and the Guangdong Natural Science Foundation (S2013010015962 and 2015A030313467).
Competing interests None declared.
Patient consent Obtained from next of kin.
Ethics approval The institutional ethics committees of First Affiliated Hospital of Guangzhou Medical University and Maoming City People’s Hospital (affiliated with Nanfang Medical University).
Provenance and peer review Not commissioned; externally peer reviewed.