Background and Purpose: Acute reperfusion therapy for patients with cardioembolic stroke (CES) is crucial because those patients often have large ischemic penumbra lesions. We investigated characteristics affecting the outcome of patients with CES treated with endovascular reperfusion therapy.
Methods: We retrospectively reviewed 229 consecutive stroke patients with acute major cerebral arterial occlusion treated with endovascular reperfusion therapy from October 2010 to December 2016. We collected the following information: baseline characteristics, NIHSS score on admission, pretreatment imaging findings, time course, endovascular procedures, degree of reperfusion, complications, discharge diagnosis of stroke subtype, and outcome. Clinical data were compared between patients with CES and patients with other stroke types. Predictors of good outcome (the modified Rankin Scale score at 90 days of 0-2) were identified in patients with CES.
Results: In 142 patients with CES, age was older (76±11 vs. 70±13 y, p<0.01), premorbid detection of atrial fibrillation (AF) was more frequent (60 vs. 7 %, p<0.01), NIHSS score on admission was higher (median, 18 vs. 15, p<0.01), the existence of susceptibility vessel sign (SVS) on MRI was more frequent (58 vs. 29 %, p<0.01), duration of endovascular procedures was shorter (90±51 vs. 143±83 min, p<0.01), and the time from onset to the end of endovascular procedures was shorter (321±204 vs. 412±238 min, p<0.01) than in 87 patients with other stroke types. There were no significant differences in reperfusion success, complications, and good outcome (42 vs. 43 %, p=0.99) between the two groups. In patients with CES, age (OR 0.44, 95% CI 0.24-0.77), premorbid detection of AF (OR 0.32, 95% CI 0.12-0.85), NIHSS score on admission (OR 0.93, 95% CI 0.87-0.98), the time from onset to the end of procedures (OR 0.97, 95% CI 0.95-0.99), and symptomatic intracranial hemorrhage (OR <0.01, 95% CI 0-0.12) were negatively associated, and successful reperfusion (OR 7.22, 95% CI 2.14-28.02) was positively associated with good outcome.
Conclusions: SVS on pretreatment MRI may be helpful in identifying CES. Patients with CES are older and severer but can be treated in a shorter time from stroke onset, cancelling the former disadvantage.