title: Endovascular treatment for acute ischaemic stroke with large vessel occlusion: the experience of a regional stroke service.
abstract: OBJECTIVE
  To report the experience of a regional stroke referral service with endovascular treatment for patients with acute ischaemic stroke (AIS) and large vessel occlusion.
  
  
  METHODS
  A prospective review was undertaken of 93 consecutive cases receiving endovascular treatment for AIS over a 42-month period (January 2010 to June 2013). The National Institutes of Health Stroke Scale (NIHSS), location of large vessel occlusion, details of endovascular procedure, and degree of reperfusion achieved (Thrombolysis In Cerebral Infarction [TICI] score) were recorded. Mortality and functional outcome (modified Rankin Scale [mRS]) were measured at 90 days.
  
  
  RESULTS
  The mean patient age was 62 years (range 26-87 years). The mean NIHSS at presentation was 16 (range 6-29). All patients had confirmed proximal large-artery occlusion on computed tomography (CT) angiography: 87 in the anterior circulation, six in the posterior circulation. Of the 93 patients treated, 64 (69%) received intravenous thrombolysis. Successful reperfusion (TICI grade 2a to 3) was achieved in 80 (86%) cases. There were 13 (14%) cases of failed vessel recanalisation (TICI grade 0). Good functional outcome (mRS ≤2) was achieved in 51 (55%) cases. The 90-day mortality was 20 (22%) cases. Fifty-seven (61%) cases were transferred from outside centres. There was no significant increase in morbidity or mortality for transferred patients.
  
  
  CONCLUSIONS
  Successful endovascular recanalisation can result in good functional outcomes for patients with AIS and large vessel occlusion. Our interventional neuroradiology service provides endovascular treatment as part of a regional stroke service without increase in morbidity or mortality for patients transferred from outside institutions.
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. Electronic address: mccusker.mark@gmail.com.
authors.forename: M W
authors.initials: MW
authors.lastname: McCusker
authors.affiliation: Department of Geriatric and Stroke Medicine, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland; Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Robinson
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Looby
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Power
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: J P
authors.initials: JP
authors.lastname: Ti
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Grech
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Galvin
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: O'Hare
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Brennan
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: O'Kelly
authors.affiliation: Department of Geriatric Medicine, Naas General Hospital, Ballymore Road, Naas, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: O'Brien
authors.affiliation: Department of Age-related Health Care, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Collins
authors.affiliation: Department of Geriatric Medicine, Connolly Hospital, Mill Road, Blanchardstown, Dublin 15, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Dolan
authors.affiliation: Department of Geriatric and Stroke Medicine, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland; Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
authors.forename: D J
authors.initials: DJ
authors.lastname: Williams
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Thornton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome