Treatment of MRA-DWI mismatched patients with mild ischemic stroke caused by middle cerebral artery M1 segment occlusion: comparison of endovascular treatment and intravenous thrombolytic therapy

Abstract

Objective \nTo investigate the effect of different treatment regimens guided by magnetic resonance angiography (MRA) and diffusion weighted imaging (DWI) mismatch on the outcomes of patients with mild ischemic stroke caused by acute middle cerebral artery (MCA) M1 segment occlusion. \n \n \nMethods \nFrom January 2013 to February 2018, the clinical data of patients with mild ischemic stroke caused by acute MCA M1 segment occlusion and admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University were analyzed retrospectively. Mild stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤5, and the MRA-DWI mismatch was defined as MCA M1 segment occlusion confirmed by MRA and the DWI-Alberta Stroke Program Early Computed Tomography Score ≥6. According to the clinical decision, they were divided into endovascular treatment group and intravenous thrombolytic therapy group. The primary outcome measure was the modified Rankin Scale score at 90 days after onset, ≤2 was defined as good outcome. The secondary outcome measure was the incidence of symptomatic intracranial hemorrhage (sICH) within 7 days after treatment and the mortality rate at 90 d. Multivariate logistic regression analysis was used to determine the independent effects of different treatment regimens on outcomes. \n \n \nResults \nA total of 38 patients were enrolled, 19 (50.00%) in the intravenous thrombolytic therapy group, and 19 in the endovascular treatment group (50.00%, including 5 patients with intratracheal thrombectomy after intravenous thrombolysis); 27 patients had good outcomes (71.05%) and 11 had poor outcomes (28.95%). Except for total cholesterol level, there were no significant differences in demography, vascular risk factors, and all baseline clinical data between the endovascular treatment group and the intravenous thrombolytic therapy group. The rate of good outcome in the endovascular treatment group was significantly higher than that in the intravenous thrombolytic therapy group (89.47% vs. 2.63%; P=0.029), and there was no significant difference between the incidence of sICH within 7 days (15.79% vs. 5.26%; P=0.604) and 90-day mortality (0% vs. 10.53%; P=0.486). The proportion of patients who underwent endovascular treatment in the good outcome group was significantly higher than that in the poor outcome group (62.96% vs. 18.18%; P=0.029). Multivariate logistic regression analysis showed that endovascular treatment was an independent predictor of good outcome (odds ratio 0.103, 95% confidence interval 0.015-0.714; P=0.021). \n \n \nConclusion \nEndovascular treatment is an independent predictor of good outcome in patients with mild ischemic stroke caused by acute MCA M1 segment occlusion. \n \n \nKey words: \nStroke;\xa0Brain ischemia;\xa0Middle cerebral artery;\xa0Severity of illness index;\xa0Magnetic resonance imaging;\xa0Magnetic resonance angiography;\xa0Thrombectomy;\xa0Endovascular procedures;\xa0Thrombolytic therapy;\xa0Tissue plasminogen activator;\xa0Treatment outcome