Abstract
Background and Purpose: In our institution, we attempt to recanalize the occluded vessels of acute ischemic stroke patients using intravenous rt-PA (IVtPA) firstly. However, for patients with an absolute contraindication to IVtPA or those with neurological severity, we perform emergency neuroendovascular revascularization (ENER). We investigated the potential role of ENER after approval of IVtPA. Methods: Among 301 consecutive acute ischemic stroke patients admitted to our institution, revascularization therapy was performed within 3 hours after stroke onset in 24 patients (8.0%). We classified these patients into two groups, those who were treated with ENER (the ENER group) and those with IVtPA (the IVtPA group), and compared the baseline NIHSS score, rate of recanalization, favorable neurologic outcome (improvement of the NIHSS score of 4 or more at 24 hours after treatment), symptomatic intracranial hemorrhage within 36 hours, and favorable clinical outcome (0-2 points on the 3-month modified Rankin Scale) between the two groups. Results: In the ENER group (n=11) and IVtPA group (n=13), the baseline NIHSS score was 20 and 16 (P<0.05); the rate of recanalization achieved was 9 and 5 patients (P<0.05); a favorable neurologic outcome was seen in 7 and 5 patients (not significant; NS); symptomatic intracranial hemorrhage occurred in 0 and 1 patients (NS); and a favorable clinical outcome was achieved in 4 and 6 patients (NS), respectively. Conclusion: Since the clinical outcome was similar in the ENER and IVtPA groups, for patients with an absolute contraindication to IVtPA or those with a severe neurological status, ENER may be the first choice of revascularization therapy.
