MECHANICAL THROMBECTOMY FOR ACUTE ISCHEMIC STROKE DUE TO LARGE VESSEL OCCLUSION: A TWOYEAR EXPERIENCE IN GREEK CENTERS OF SITS REGISTRY

Abstract

Introduction: Mechanical Thrombectomy (MT) is the current standard of care for the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Safety and efficacy of MT has not been systematically studied in Greece.
Aim: We evaluated the safety and efficacy of MT in AIS patients due to LVO using data from Greek centers participating in The Safe Implementation of Treatments in Stroke (SITS) registry and compared different endpoints to patients from the Highly Effective Reperfusion evaluated in Multiple Endovascular Stroke Trials (HERMES) collaboration cohort. 
Methods: We prospectively evaluated consecutive AIS patients with LVO who were treated with MT in 5 Greek hospitals during a two year-period. Safety endpoints included the prevalence of peri-procedural complications, symptomatic intracranial hemorrhage (sICH) and mortality. The rates of complete reperfusion (TICI IIb/III), neurological improvement at 24 hours (defined as a NIHSS reduction by 8 points at 24 hours in comparison to admission NIHSS-score) and 7 days post-stroke, three-month functional independence (modified Rankin score 0-2) were used as efficacy endpoints. Patient demographics, safety and efficacy endpoints were compared to the HERMES cohort.
Results: A total of 30 patients with AIS due to LVO (mean age 55 years, 67% men, median NIHSS-score 18 points, IQR: 13-22) were treated with MT (median onset to groin puncture time: 270 min) in 5 tertiary centers. The rates complete reperfusion (78%) and early neurological improvement at 24 hours (47%) were comparable to those of HERMES cohort (71% & 50% respectively). Three-month mortality was 23% in the Greek cohort and 15% in the HERMES cohort, whereas sICH occurred in 6.6% of our patients (4.4% in HERMES cohort). The rates of three-month functional independence were 43% and 46% in the Greek and HERMES cohort.
Conclusions: The present report confirms safety and efficacy of MT in AIS patients due to LVO in Greece. Further implementation of MT in the clinical practice of Greek stroke centers with specialized Neurology, Anesthesiology and Interventional Radiology Departments is required.