title: Outcome Evaluation of Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy: A Single-Institution Experience in the Era of Randomized Controlled Trials.
abstract: BACKGROUND
  Endovascular thrombectomy is an effective procedure to treat selected ischemic strokes, as shown in recent randomized controlled trials (RCTs). The generalizability of these trial data to real-world settings, however, is unknown. The aim of this study was to examine our single-center experience with endovascular thrombectomy for acute ischemic strokes and perform a comparative outcome analysis to the most recent RCTs.
  
  
  METHODS
  We performed a 5-year retrospective analysis, from April 2011 to March 2016, on 66 consecutive patients with acute ischemic stroke who received endovascular thrombectomy at our institution. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale were used to assess preoperative status. Our primary outcomes were the modified Rankin Score (mRS) at 90 days and recanalization grade measured by the 6-point thrombolysis in cerebral infarction (TICI) grading system.
  
  
  RESULTS
  Sixty-six patients received endovascular treatment during the study period. Among the patients examined, 35 (53%) had a favorable outcome (mRS 0-2 at 90 days), 23 (35%) a poor outcome (mRS 3-5), and 8 (12%) died. Successful recanalization (TICI score 3-5) was achieved in 68% of cases. In univariate analysis, patients with good outcome at 90 days had significantly greater ASPECTS, lower National Institutes of Health Stroke Scale, and higher TICI scores. In a multiple logistic regression model, higher ASPECTS and TICI scores were significantly and independently associated with favorable outcome.
  
  
  CONCLUSIONS
  Excellent outcomes, as demonstrated by the recent RCTs, can be achieved in clinical practice and reproduced in dedicated tertiary centers.
authors.affiliation: Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sarzetto
authors.affiliation: Faculty of Applied Sciences and Engineering, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shaurya
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Naif M
authors.initials: NM
authors.lastname: Alotaibi
authors.affiliation: Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Howard
authors.affiliation: Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Leodante
authors.initials: L
authors.lastname: da Costa
authors.affiliation: Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Heyn
authors.affiliation: Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Pejman Jabehdar
authors.initials: PJ
authors.lastname: Maralani
authors.affiliation: Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Daipayan
authors.initials: D
authors.lastname: Guha
authors.affiliation: Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Swartz
authors.affiliation: Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Karl
authors.initials: K
authors.lastname: Boyle
authors.affiliation: Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Faculty of Applied Sciences and Engineering, University of Toronto, Toronto, Ontario, Canada. Electronic address: Victor.Yang@sunnybrook.ca.
authors.forename: Victor X D
authors.initials: VXD
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001488:Basilar Artery / Q000601:surgery; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D002341:Carotid Artery Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy; D002343:Carotid Artery, Internal / Q000601:surgery; D002533:Cerebral Angiography; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Endovascular; Stroke; Thrombectomy