RESUMO
BACKGROUND AND PURPOSE: In recent trials, acute ischemic stroke (AIS) from large artery occlusion (LAO) was resistant to intravenous thrombolysis and adjunctive stent retriever thrombectomy (SRT) was associated with better perfusion and outcomes. Despite benefit, 39-68% of patients had poor outcomes. Thrombectomy in AIS with LAO within 3â h is performed secondary to intravenous thrombolysis, which may be associated with delay. The purpose of our study is to evaluate the safety, feasibility, recanalization rate, and outcome of primary SRT within 3â h without intravenous thrombolysis in AIS from LAO. METHODS: Based on an institutionally approved protocol, stroke patients with LAO within 3â h were offered primary SRT as an alternative to intravenous recombinant tissue plasminogen activator. Consecutive patients who underwent primary SRT for LAO within 3â h from 2012 to 2014 were enrolled. Outcomes were measured using the modified Rankin Scale (mRS). RESULTS: 18 patients with LAO of mean age 62.83±15.32â years and median NIH Stroke Scale (NIHSS) score 16 (10-23) chose primary SRT after giving informed consent. Near complete (TICI 2b in 1 patient) or complete (TICI 3 in 17 patients) recanalization was observed in all patients. Time to recanalization from symptom onset and groin puncture was 188.5±82.7 and 64.61±40.14â min, respectively. NIHSS scores immediately after thrombectomy, at 24â h and 30â days were 4 (0-12), 1 (0-12), and 0 (0-4), respectively. Asymptomatic perfusion-related hemorrhage developed in four patients (22%). 90-day outcomes were mRS 0 in 50%, mRS 1 in 44.4%, and mRS 2 in 5.6%. CONCLUSIONS: Our study demonstrates that primary SRT in AIS from LAO is safe and feasible and is associated with complete recanalization and good outcome. Further study is required.