title: Efficacy of endovascular treatment for acute cerebral large-vessel occlusion: analysis of nationwide prospective registry.
abstract: BACKGROUND
  The aim of this nationwide, prospective registry of acute cerebral large-vessel occlusion was to assess the efficacy of endovascular treatment (EVT) on outcome in the "real-world" settings.
  
  
  METHODS
  Medical information of the patients was anonymized and registered prospectively through a Web site from 84 medical centers in Japan. Reperfusion of the affected arteries was evaluated by the Thrombolysis in Cerebral Infarction grade on cerebral angiography or by the modified Mori grade on magnetic resonance angiography. Clinical outcome was evaluated by modified Rankin Scale (mRS) at 90 days after onset. Symptomatic intracranial hemorrhage and procedure-related complications were also analyzed.
  
  
  RESULTS
  Among intravenous tissue plasminogen activator (IV t-PA)-failed patients, no significant difference in favorable outcome was seen with or without EVT overall (41.7% versus 36.8%, P = .55). However, EVT significantly increased favorable outcomes (mRS score 0-2) in patients with internal carotid artery (ICA)/middle cerebral artery M1/basilar artery (BA) occlusion (41.3% versus 20.5%, P = .019). In contrast, among t-PA-ineligible patients, EVT significantly increased favorable outcomes overall (29.1% versus 19.5%; odds ratio, 1.70; P = .007). Furthermore, favorable outcomes were more common in patients with ICA/M1/BA occlusion (29.0% versus 10.3%; odds ratio, 3.56; P < .0001). Multivariate analysis also confirmed the efficacy of IV t-PA, EVT, and their combination for favorable outcome.
  
  
  CONCLUSIONS
  EVT significantly improved clinical outcomes in IV t-PA-failed and t-PA-ineligible patients with ICA/M1/BA occlusion. These findings support the introduction of EVT for acute proximal artery occlusion.
authors.affiliation: Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya. Electronic address: shinichiyoshimura@hotmail.com.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yoshimura
authors.affiliation: Department of Neurosurgery, Kobe City Medical Center, Kobe.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sakai
authors.affiliation: Stroke Center, Kyusyu Medical Center, Fukuoka.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
authors.affiliation: Department of Neurology, Osaka University, Suita.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitagawa
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka.
authors.forename: Norio
authors.initials: N
authors.lastname: Tanahashi
authors.affiliation: Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo.
authors.forename: Toshio
authors.initials: T
authors.lastname: Hyogo
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamagami
authors.affiliation: Department of Neurosurgery, Gifu University, Gifu, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Egashira
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007564:Japan; D018810:Magnetic Resonance Angiography; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute stroke; endovascular treatment; large-vessel occlusion; national registry; tissue plasminogen activator