title: Prospective acute ischemic stroke outcomes after endovascular therapy: a real-world experience.
abstract: OBJECTIVE
  To report results of endovascular therapy for acute ischemic stroke (AIS) in patients who were not candidates for intravenous thrombolysis (IVT) or in whom IVT failed.
  
  
  METHODS
  Prospectively collected data for patients treated between January 2006 and June 2009 were analyzed retrospectively. After careful patient and therapy selection, 213 AIS patients with a mean NIHSS score of 14.2 at presentation underwent intervention. End points analyzed were Thrombolysis in Myocardial Infarction (TIMI) 2/3 reperfusion, symptomatic intracranial hemorrhage (SICH) rates, and 90-day outcomes (modified Rankin Scale [mRS] and mortality). Multivariate binary logistic regression analysis was used to assess independent predictors of end points.
  
  
  RESULTS
  Of 189 patients with anterior circulation occlusions, 135 were treated within 0-8 hours, 33 were treated after 8 or more hours, and 21 were treated after wake-up stroke (WUS). Among 24 patients treated with posterior circulation occlusions, 4 had WUS. After treatment, 72.3% patients had TIMI 2/3 reperfusion; SICH rate was 8.7%; at 90 days, 36.6% recovered to mRS 2 or less. SICH rate was higher in patients with anterior circulation strokes who received treatment 8 or more hours after symptom onset (odds ratio [OR] = 3.8) and patients with WUS (OR = 4.9). In patients treated within 8 hours of onset of symptoms of anterior circulation stroke, SICH rate was only 6.7%. There was no difference in outcomes in patients with WUS compared with patients treated less than 8 hours after stroke onset.
  
  
  CONCLUSIONS
  This is the first and largest prospective study to the authors' knowledge that shows endovascular therapy for AIS patients in a real-world setting. High recanalization rates with low SICH rates were achieved using careful patient and therapy selection.
authors.affiliation: Department of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors.forename: Sabareesh K
authors.initials: SK
authors.lastname: Natarajan
authors.forename: Yuval
authors.initials: Y
authors.lastname: Karmon
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.forename: Hajime
authors.initials: H
authors.lastname: Ohta
authors.forename: Erik F
authors.initials: EF
authors.lastname: Hauck
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome