Introduction: Several randomized trials showed the endovascular thrombectomy (EVT) was effective in patients with acute cerebral large vessel occlusion, but the efficacy to general patients were unknown.
Methods: Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan Registry 2 was prospective registry of acute cerebral large vessel occlusion at centers in Japan. The patients were 20 years or elder and admitted within 24 hours after the onset of cerebral large vessel occlusion in both anterior and posterior circulation. Primary endpoint was good outcome defined by modified Rankin Scale (mRS) of 0-2 at 90 days after onset. Secondary endpoint was mortality. Adjusted odds ratio (OR) was estimated by logistic regression model accounted for potential confounders. Safety endpoints were all bleeding included intracerebral hemorrhage, gastrointestinal bleedings, recurrence of stroke, and other adverse events within 90 days.
Results: Consecutive 2420 patients were recruited from October 2014 to September 2016, and follow-up ended at January 2017. Excluding 12 patients who did not meet inclusion criteria, 1281 patients were treated with EVT and 1127 were without. Mean age was 75 and 77 years in EVT and no-EVT groups, respectively. Posterior circulation accounted for 13% in both groups. Intravenous alteplase was administered in 47% and 32% of EVT and no-EVT groups, respectively. Good outcome was observed in 41.7% and 30.7% the EVT group and no-EVT group, respectively (p<0.0001). Adjusted OR of good outcome of EVT relative to no-EVT was 1.79 (95%CI: 1.39-2.29). Prespecified subgroup analyses showed the EVT was effective in anterior circulation [adjusted OR 1.7 (95%CI 1.3-2.2)] while not effective in posterior circulation [adjusted OR 1.3. (95%CI 0.6-3.0)] (interaction p=0.34). The mortality was 8.8% and 13.6% in EVT group and no-EVT group (p=0.0002). Intracerebral bleeding occurred within 72 hours from onset in 26% in EVT group while 19% in no-EVT group (p<0.0001).
Conclusions: EVT was shown effective in general patients with acute cerebral large vessel occlusion in terms of mRS and mortality at 90 days. The indication of EVT for posterior circulation should be reconsidered.