Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2022; 10(28): 10077-10084
Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10077
Endovascular treatment vs drug therapy alone in patients with mild ischemic stroke and large infarct cores
Wen-Hui Kou, Xiao-Qin Wang, Jin-Shui Yang, Nan Qiao, Xiao-Hui Nie, Ai-Mei Yu, Ai-Xia Song, Qian Xue
Wen-Hui Kou, Xiao-Qin Wang, Jin-Shui Yang, Nan Qiao, Xiao-Hui Nie, Ai-Mei Yu, Ai-Xia Song, Qian Xue, Department of Neurology, First Affiliated Hospital of Hebei North University, Zhangjiakou 075061, Hebei Province, China
Author contributions: Kou WH, Wang XQ, Yang JS, Qiao N, Nie XH, Yu AM, Song AX, and Xue Q designed the research study; Kou WH, Wang XQ, and Yang JS performed the research; and all authors have read and approved the final manuscript.
Supported by Scientific Research Fund of Hebei Health Commission 2022, No. 20220591.
Institutional review board statement: The study was reviewed and approved by the First Affiliated Hospital of Hebei North University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ai-Xia Song, MD, Associate Chief Physician, Department of Neurology, First Affiliated Hospital of Hebei North University, No. 12 Changqing Road, Zhangjiakou 075061, Hebei Province, China. 1979958315@qq.com
Received: June 12, 2022
Peer-review started: June 12, 2022
First decision: July 14, 2022
Revised: August 2, 2022
Accepted: August 22, 2022
Article in press: August 22, 2022
Published online: October 6, 2022
Processing time: 107 Days and 1.5 Hours
Abstract
BACKGROUND

Treatment decision making is strictly associated with the outcomes in patients with ischemic stroke who show a large core infarct. Medical care alone may result in suboptimal treatment efficacy, and endovascular treatment may be accompanied by safety issues. Whether endovascular treatment is superior to medical care is not well investigated in the clinical studies.

AIM

To investigate the efficacy of endovascular treatment and drug therapy alone in mild ischemic stroke patients with large infarct cores.

METHODS

Fifty patients with mild ischemic stroke and 50 patients with acute ischemic stroke caused by anterior large vessel occlusion were selected at the First Affiliated Hospital of Hebei North University between January 2021 and December 2021. Patients were divided into an endovascular therapy group and a drug therapy group according to different treatment methods. In the endovascular therapy group, there were 28 patients with minor stroke and 22 patients with large infarct cores. The drug therapy group had 22 patients with minor stroke and 28 patients with large infarct cores. The National Institutes of Health Stroke Scale (NIHSS) scores were collected and compared between the two groups immediately after the operation and 24 h and 7 d after the operation. The modified Rankin scale (mRS) and/or activity of daily living were assessed at hospital discharge.

RESULTS

There was no significant difference in NIHSS scores between the two groups before the operation (P > 0.05). NIHSS scores were lower in the endovascular therapy group than in the drug therapy group at 24 h and 7 d after the operation and at hospital discharge (all P < 0.05). The incidence of early neurologic deterioration was significantly lower in the endovascular therapy group than in the drug therapy group (P < 0.05). At hospital discharge, the mRS score was lower in the endovascular treatment group than in the drug therapy group, and the activity of daily living score was better in the endovascular treatment group than in the drug therapy group (all P < 0.05). During a follow-up of 3 mo, 17 patients (34.0%) had good prognosis (mRS ≤ 2), 33 patients (66.0%) had poor prognosis (mRS > 2), and 11 patients (22.0%) died. In the medical treatment group, 16 patients (mRS ≤ 2) had good prognosis (32.0%), 34 patients (mRS > 2) had poor prognosis (68.0%), and 14 patients (28.0%) died. There was no significant difference in prognosis and mortality between the two groups (P > 0.05).

CONCLUSION

Endovascular therapy can improve NIHSS score and mRS score in patients with mild ischemic stroke and large infarct cores. It is suitable for clinical application.

Keywords: Ischemic stroke; Large infarct cores; Endovascular therapy; Drug therapy; Efficacy

Core Tip: Fast and correct first aid can save lives and avoid disabilities in patients with acute ischemic stroke. The limited therapeutic time window and relative contraindications confine medical care for the treatment of acute ischemic stroke. Endovascular therapy ranks among the major therapies from an important alternative for medical therapy in the treatment of acute ischemic stroke. The present study compared the clinical efficacy and safety of these two treatment approaches in patients with acute ischemic stroke. It found that the two approaches achieved comparable results in favorable prognosis. However, endovascular therapy can effectively improve neurological function compared with medical therapy.