ENDOVASCULARAPPROACHES TOACUTE ISCHEMIC STROKE- INDIAN PERSPECTIVE

Aim: To review literature about endovascular approaches to acute ischemic stroke and provide Indian perspective about managing these cases. Brief Summary: In acute ischemic stroke cases, intravenous thrombolysis (IVT) with altepase within 4.5 hours has been the standard of care. Due to certain limitations of IVT, in pooled patientlevel data from 5 trials (HERMES [Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials], which included the 5 trials MR CLEAN, ESCAPE, REVASCAT, SWIFT PRIME, and EXTEND-IA), mechanical thrombectomy (MT) is indicated for patients with acute ischemic stroke due to a large artery occlusion (LVO) in the anterior circulation who can be treated within 24 hours of the time last known to be well (ie, at neurologic baseline), regardless of whether they received intravenous alteplase for the same ischemic stroke event. The maximum benefit can be achieved within 6 hours of onset of symptoms. There are studies suggesting the benefit of MT in posterior circulation stroke as well as in distal arteries. We are going to review the methodology of endovascular techniques in brief alongwith Indian perspective on feasibility of this treatment approach in AIS. Conclusion: Mechnicalthrombectomy is certainly an effective modality of treatment in large vessel occlusion in anterior circulation within 24 hours. More awareness regarding the approach in India, can reduce the stroke morbidity and mortality in many of the cases in future

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Abstract WP40: “Good” Angiographic Collateral Circulation Correlates With Lower Dwi Infarct Volumes In Acute Ischemic Stroke

Stroke ◽

10.1161/str.44.suppl_1.awp40 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Esteban Cheng-Ching ◽

Dolora Wisco ◽

Shumei Man ◽

Ferdinand Hui ◽

Gabor Toth ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Symptom Onset ◽

Collateral Circulation ◽

Infarct Volume ◽

Artery Occlusion ◽

Grading System ◽

Large Artery ◽

Anterior Circulation ◽

Vessel Occlusion

Background and purpose Large artery occlusion leads to ischemic stroke which volume is influenced by time from symptom onset. This effect is modulated by several factors, including the presence and degree of collateral circulation. We analyze the correlation between a standard angiographic collateral grading system and DWI infarct volumes. Methods We reviewed a prospectively collected retrospective database of ischemic stroke patients admitted between august of 2006 and december of 2011. We included patients with anterior circulation acute ischemic stroke presenting within 8 hours from symptom onset with large vessel occlusion, who underwent pre-treatment MRI and endovascular therapy. DWI infarct volumes were measured by region of interest. ASITN collateral grading system was used and grouped into “good collaterals” for grades 3 and 4, and “poor collaterals” for grades 0, 1 and 2. JMP statistical software was utilized. Results 152 patients (71 (46.7%) male, mean age: 68±15 years;) were included in the initial analysis. We identified 49 patients who had angiographic collateral circulation grading. Seven patients had ASITN collateral grade 0 with mean infarct volume of 27.6 cc, 25 had collateral grade of 1 with mean infarct volume of 27.9 cc, 10 had collateral grade of 2 with mean infarct volume of 23.4 cc, 5 had collateral grade of 3 with mean infarct volume of 6.3 cc, and 2 had collateral grade of 4 with mean infarct volume of 14.6 cc. Forty two patients had “poor collaterals” with a mean infarct volume of 26.8 cc. Seven patients had “good collaterals” with mean infarct volume of 8.7 cc. When comparing the infarct volumes between these two groups, the difference was statistically significant (p=0.017). Conclusions In anterior circulation acute ischemic stroke, “good” angiographic collateral circulation defined as ASITN grading system of 3 or 4, correlates with lower infarct volumes on presentation.

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Bridging Therapy and Direct Thrombectomy for Acute Ischemic Stroke: A Prospective Cohort Study

Journal of Stroke Medicine ◽

10.1177/2516608520976275 ◽

2020 ◽

Vol 3 (2) ◽

pp. 124-130

Author(s):

Trung Quoc Nguyen ◽

Anh Le Tuan Truong ◽

Hoang Thi Kim Phan ◽

Duan Duy Nguyen ◽

Khang Vinh Nguyen ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Therapy Group ◽

Intravenous Thrombolysis ◽

Functional Independence ◽

Artery Occlusion ◽

Large Artery ◽

Bridging Therapy ◽

Vessel Occlusion ◽

Reperfusion Rate

Background: It remains controversial if intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MTE) is superior to MTE alone in patients with acute ischemic stroke caused by large vessel occlusion. We aim to compare functional outcomes, mortality, reperfusion, and intracranial hemorrhage rates in bridging therapy (IVT prior thrombectomy) and MTE alone groups within 6 h from symptom onset. Materials and Methods: Consecutive hospitalized patients (September 2017 and July 2018) with acute large artery occlusion within the anterior cerebral circulation eligible for MTE with or without prior IVT were included. A modified Rankin Scale score of 0 to 2 was considered as good functional outcome at 90 days. Successful reperfusion was defined as a Thrombolysis in Cerebral Infarction scale of 2b to 3. Results: Of the 124 patients included, 56 (45.2%) received bridging therapy and 68 (54.8%) received MTE alone. Patients receiving bridging therapy were younger (median, 56 vs 63, P = .045) and had shorter onset-to-groin time (median, 270 vs 370 min, P < .001) than those receiving MTE alone. Successful reperfusion rate was significantly greater in the bridging therapy group (87.5% vs 72.1%, P = 0.03). There were no statistically significant differences between the 2 groups in functional independence (bridging 58.9% vs 75.0%, P = 0.07), mortality at 90 days (bridging 14.3% vs 7.4%, P = 0.22), parenchymal hematoma type 2 (bridging 3.6% vs 2.9%, P > .99), and any hemorrhage (bridging 42.3% vs 26.5%, P = 0.07). Conclusion: Compared to MTE alone, bridging therapy with IVT improved the reperfusion rate but not other outcomes. Further clinical trials are needed to confirm our findings.

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Abstract WP39: Mechanical Embolectomy for Acute Ischemic Stroke Beyond Six Hours From Symptom Onset Using Advanced MR Imaging

Stroke ◽

10.1161/str.48.suppl_1.wp39 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ryan McTaggart ◽

Shadi Yaghi ◽

Daniel C Sacchetti ◽

Richard Haas ◽

Shawna Cutting ◽

...

Keyword(s):

Ischemic Stroke ◽

Mr Imaging ◽

Acute Ischemic Stroke ◽

Large Vessel ◽

Lesion Volume ◽

Large Artery ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Good Outcome

Background: There is very limited data on the use of advanced neuroimaging to select patients with acute ischemic stroke and large vessel occlusion for intraarterial therapy beyond 6 hours from onset. Our aim is to report the outcome of patients with acute ischemic stroke and large artery occlusion who presented beyond 6 hours from onset, had favorable MRI imaging profile, and underwent mechanical embolectomy. Methods: This is a single institution retrospective study between December 1st, 2015, and July 30 th , 2016 with acute ischemic stroke and anterior circulation large vessel occlusion (LVO) with ASPECTS of 6 or more and beyond 6 hours from symptoms onset. Favorable imaging profile was defined as 1) DWI lesion volume (as defined as apparent diffusion coefficient < 620 X 10-6 mm2/s) of 70 mL or less AND 2) Penumbra volume (as defined by volume of tissue with Tmax >6 sec) of 15 mL or greater AND 3) A mismatch ratio of 1.8 or more AND 4) Volume of tissue with perfusion lesion with Tmax > 10 sec is less than 100 mL. Good outcome was defined as a 90 day mRS≤2. Results: In the study period, 41 patients met the inclusion criteria; 22 (53.6%) had favorable imaging profile and underwent mechanical embolectomy. The median age was 75 years (59-92), 68.2% were females; the median time from last known normal to groin puncture was 684.5 minutes (range 363-1628) and the median admission NIHSS score was 17.5 (range 4-28). The rate of good outcomes in this series was similar to that in a patient level pooled meta-analysis of the recent endovascular trials (68.2% vs. 46.0%, p=0.07). The rate of good outcome matches that of the EXTEND-IA trial that selected patients using perfusion imaging (68.2% vs. 71.0%, p = 1.00). None of the patients in our cohort had symptomatic intracereberal hemorrhage. Conclusion: Advanced MR imaging may help select patients with acute ischemic stroke and anterior circulation large vessel occlusion for embolectomy beyond the treatment window used in most endovascular trials.

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Endovascular Recanalization in Early Recurrent Ischemic Stroke: A Treatment Challenge

Case Reports in Neurology ◽

10.1159/000507185 ◽

2020 ◽

Vol 12 (Suppl. 1) ◽

pp. 49-55

Author(s):

Huong Bich Thi Nguyen ◽

Thang Huy Nguyen

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Time Window ◽

Recurrent Stroke ◽

Reperfusion Therapy ◽

Artery Occlusion ◽

Large Artery ◽

Limited Information ◽

Anterior Circulation ◽

Endovascular Recanalization

Reperfusion therapy is the most effective treatment for acute ischemic stroke. At present, many clinical studies have shown that mechanical thrombectomy is efficient and safe for acute ischemic stroke of large artery occlusion disease in the time window of 24 h. However, there is limited information on the safety and effectiveness of this technique in cases of recurrent ischemic stroke. We report a case of early recurrent stroke of the anterior circulation after a week of the first stroke. Imaging examinations showed that there existed occlusion of corresponding vessels and obvious ischemic penumbra. Symptoms of the patient were progressive worsening and medical treatment failed; therefore, the corresponding vessel was opened. The low perfusion status in brain tissue and clinical defect symptoms of the patients have improved a lot. In conclusion, thrombectomy for early recurrent ischemic stroke may be effective. Moreover, there may be a wider reperfusion time window for ischemic stroke patients.

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Abstract WMP5: Predictors and Clinical Relevance of Hemorrhagic Transformation after Endovascular Therapy for Acute Ischemic Stroke: a Multicenter Retrospective Analysis of 1122 Patients

Stroke ◽

10.1161/str.44.suppl_1.awmp5 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Raul G Nogueira ◽

Rishi Gupta ◽

Tudor G Jovin ◽

Elad I Levy ◽

David Liebeskind ◽

...

Keyword(s):

Diabetes Mellitus ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Retrospective Analysis ◽

Endovascular Therapy ◽

High Volume ◽

Artery Occlusion ◽

Large Artery ◽

Anterior Circulation

Background and Purpose: Endovascular techniques are frequently employed to treat large artery occlusion in acute ischemic stroke (AIS). We sought to determine the predictors and clinical impact of intracranial hemorrhage (ICH) after endovascular therapy. Methods: Retrospective analysis of consecutive patients presenting to 13 high-volume stroke centers with AIS due to proximal occlusion in the anterior circulation who underwent endovascular treatment within 8 hours from symptom onset. Logistic regression was performed to determine the variables associated with ICH, hemorrhagic infarction (HI), and parenchymal hematomas (PH) as well as 90-day poor outcome (mRS≥3), and mortality. Results: A total of 1122 patients (mean age, 67±15 years; median NIHSS, 17 [IQR13-20]) were studied. Independent predictors for HI included diabetes mellitus (OR 2.27, 95%CI [1.58-3.26], p<0.0001), pre-procedure IV tPA (1.43[1.03-2.08], p<0.037), Merci thrombectomy (1.47[1.02-2.12], p<0.032), and longer time to puncture (1.001[1.00-1.002], p<0.026). Patients with atrial fibrillation (1.61[1.01-2.55], p<0.045) had a higher risk of parenchymal hematomas (PH) while the use of intra-arterial tPA (0.57[0.35-0.90], p<0.008) was associated with lower chances of PH. Both the presence of HI (2.23[1.53-3.25], p< 0.0001) and PH (6.24[3.06-12.75], p< 0.0001) were associated with poor functional outcomes; however, only PH was associated with higher mortality (3.53[2.19-5.68], p<0.0001). Conclusions: In AIS patients undergoing endovascular therapy, diabetes mellitus, longer time to treatment, and Merci thrombectomy appear to be associated with a higher risk for HI while atrial fibrillation appears to result in a higher risk for PH. While both HI and PH are associated with poor outcomes only PH is associated with higher mortality.

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Thrombectomy in acute ischemic stroke: estimations of increasing demands

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012575 ◽

2016 ◽

Vol 9 (9) ◽

pp. 830-833 ◽

Cited By ~ 7

Author(s):

Åsa Kuntze Söderqvist ◽

Tommy Andersson ◽

Niaz Ahmed ◽

Nils Wahlgren ◽

Magnus Kaijser

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Artery Occlusion ◽

University Hospital ◽

Stroke Severity ◽

Large Artery ◽

Anterior Circulation ◽

Stroke Treatment ◽

Stroke Registry ◽

New Treatment

BackgroundNew recommendations for mechanical thrombectomy in acute ischemic stroke suggest that thrombectomy should be considered for eligible patients with a large artery occlusion in the anterior circulation within 6 hours of stroke onset. The resources are unevenly spread and, in order to be able to meet a potentially increased demand, we have estimated the future need for thrombectomy.MethodsThe new treatment recommendations are similar to those that have been in use at the Karolinska University Hospital since 2007. Using our local thrombectomy data (2009–2011), we calculated the proportion of thrombectomies performed at our hospital by level of stroke severity according to the National Institutes of Health Stroke Scale score (0–5, 6–11, 12–19, and 20–35). We then estimated the total number of potential thrombectomies expected in Sweden by extrapolating our treatment proportions to the rest of Sweden through the use of data from the Swedish National Stroke Registry.ResultsThe number of potential thrombectomies would have been more than five times higher (1268 estimated compared with 232 actually reported in the National Stroke Registry) if the new recommendations for thrombectomy in acute ischemic stroke had been implemented in 2013 (the year from which we had the most recent available data from the Swedish Stroke Registry).ConclusionsWhen the new recommendations are implemented broadly, there may be a substantial increase in demand for thrombectomies. Our study highlights the need for policymakers and healthcare professionals to prepare for the increasing demands for advanced endovascular stroke treatment.

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Cortical Venous Changes on Susceptibility-Weighted Imaging Predict the Cerebral Collateral Circulation as Confirmed by Digital Subtraction Angiography

Frontiers in Neurology ◽

10.3389/fneur.2021.691430 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yun-Hao Zhan ◽

Yang-Kun Chen ◽

Run-Xiong Li ◽

Gen-Pei Luo ◽

Zhi-Qiang Wu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Collateral Circulation ◽

Artery Occlusion ◽

Susceptibility Weighted Imaging ◽

Large Artery ◽

Digital Subtraction ◽

Stroke Patients ◽

Severe Stenosis ◽

Anterior Circulation

Objective: Asymmetrical cortical vein sign (ACVS) shown on susceptibility-weighted imaging (SWI) can reflect regional hypoperfusion. We investigated if ACVS could predict the cerebral collateral circulation (CC) as assessed by digital subtraction angiography (DSA) in acute ischemic stroke patients with ipsilateral severe stenosis/occlusion of the anterior circulation.Methods: Clinical data and imaging data of 62 acute ischemic stroke patients with ipsilateral severe stenosis or occlusion of the anterior circulation confirmed by DSA were collected retrospectively. Participants underwent magnetic resonance imaging, including an SWI sequence. ACVS was defined as more and/or larger venous signals in the cerebral cortex of one side of SWI than that in the contralateral side. ACVS was measured using the Alberta Stroke Program Early Computed Tomography score based on SWI. The grading of the cerebral CC was judged using DSA.Results: Of the 62 patients, 30 patients (48.4%) had moderate-to-severe ACVS. According to DSA assessment, 19 patients (30.6%) had a good CC (grade 3–4), and 43 (69.4%) patients had a poor-to-moderate CC (grade 0–2). Among the 30 patients with moderate-to-severe ACVS, only three (10%) patients had a good CC, and 27 (90%) patients had a poor-to-moderate CC; among the 32 patients with none or mild ACVS, 16 (50%) of them had a good CC, and the other 50% had a moderate-to-severe CC. We constructed two logistic regression models with ACVS grading and none or mild ACVS entered into the models, respectively, together with age and large-artery occlusion. In model 1, no ACVS (compared with severe ACVS; OR = 40.329, 95%CI = 2.817–577.422, P = 0.006), mild ACVS (compared with severe ACVS; OR = 17.186, 1.735–170.224, 0.015) and large-artery occlusion (OR = 45.645, 4.603–452.592, 0.001) correlated with a good CC. In model 2, none or mild ACVS (OR = 36.848, 95%CI = 5.516–246.171, P < 0.001) was significantly associated with a good CC as judged by DSA, adjusted by age and large-artery occlusion.Conclusions: Cortical venous changes in SWI may be a useful indicator for the cerebral CC as confirmed by DSA.

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Prognosis of asymptomatic intracranial hemorrhage after endovascular treatment

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013848 ◽

2018 ◽

Vol 11 (2) ◽

pp. 123-126 ◽

Cited By ~ 5

Author(s):

Yonggang Hao ◽

Wenhua Liu ◽

Huaiming Wang ◽

Wenjie Zi ◽

Dong Yang ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Functional Outcomes ◽

Artery Occlusion ◽

Favorable Outcome ◽

Large Artery ◽

Anterior Circulation ◽

Excellent Outcome

ObjectiveAsymptomatic intracranial hemorrhage (aSICH) is a common phenomenon after endovascular treatment of acute ischemic stroke, but its prognostic impacts remain unclear. This study evaluated functional outcomes of thrombectomy in patients with and without aSICH.MethodsPatients with acute ischemic stroke due to large artery occlusion in the anterior circulation who were treated with thrombectomy were enrolled in 21 centers. According to CT scans performed within 72 hours of endovascular procedures, patients with aSICH or without intracranial hemorrhage were included while patients with symptomatic intracranial hemorrhage (SICH) were excluded. Baseline data and functional outcomes were compared between patients with aSICH and those without intracranial hemorrhage. Logistic regression analysis was applied to evaluate the impacts of aSICH on functional outcomes.ResultsOf the 632 patients with endovascular treatment, 101 (16.0%) were classified as having SICH, 212 (33.5%) as having aSICH, and 319 (50.5%) as being without intracranial hemorrhage. Patients with aSICH after endovascular treatment had a lower ratio of excellent outcome (mRS 0–1, OR 0.53; 95% CI 0.33 to 0.84, P=0.007) than those without intracranial hemorrhage. There were no significant differences concerning favorable outcome (mRS 0–2, OR 0.76; 95% CI 0.50 to 1.14, P=0.185) or mortality (OR 0.64; 95% CI 0.38 to 1.09, P=0.101) between patients with aSICH and those without intracranial hemorrhage.ConclusionsIn an Asian population, aSICH after thrombectomy may decrease the likelihood of an excellent functional outcome but does not influence a favorable outcome and mortality in patients with ischemic stroke due to large artery occlusion in the anterior circulation.

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Intravenous Thrombolysis and Endovascular Thrombectomy in Acute Ischemic Stroke with Minor Symptom

Journal of the Korean Neurological Association ◽

10.17340/jkna.2021.1.2 ◽

2021 ◽

Vol 39 (1) ◽

pp. 10-18

Author(s):

Dae-Hyun Kim

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Recurrent Stroke ◽

Intravenous Thrombolysis ◽

Treatment Decision ◽

Recombinant Tissue Plasminogen Activator ◽

Large Artery ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Mild Stroke

More than 50% of all patients with ischemic stroke initially present with mild symptoms. Despite the mild clinical presentation, a high percentage of these patients develop stroke progression with consequent disability, recurrent stroke, or death at follow-up. Intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 hours has been proven to be an effective treatment for acute ischemic stroke, but the risk-benefit ratio of this therapeutic approach remains still unclear in patients with mild stroke. Many patients with mild stroke are frequently excluded from thrombolysis. Large artery occlusion is an important predictor of early neurological deterioration or poor outcomes in patients with mild ischemic stroke. However, current guidelines do not recommend endovascular thrombectomy in patients with National Institutes of Health Stroke Scale score of <6 points. Some previous retrospective cohort studies have reported that endovascular thrombectomy showed promising results in cases of acute mild ischemic stroke with large vessel occlusion. Treatment decisions in patients with mild ischemic stroke should be individualized depending on clinical and radiological features. In this review, we discuss the prognosis of mild strokes, efficacy of intravenous thrombolysis and endovascular thrombectomy, and the role of neurovascular imaging in treatment decision making in this patient population.

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Abstract P493: Outcomes in Young Adults With Acute Ischemic Stroke Undergoing Endovascular Thrombectomy: A Multi-Centre Experience

Stroke ◽

10.1161/str.52.suppl_1.p493 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Vanessa Chen ◽

Benjamin Tan ◽

Aloysius Tan ◽

Lukas Meyer ◽

Jens Fiehler ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Intravenous Thrombolysis ◽

Anterior Circulation ◽

Multicenter Cohort Study ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Stroke Etiology

Introduction: Endovascular thrombectomy(EVT) is considered standard of care for anterior circulation acute ischemic stroke(AIS) with large vessel occlusion(LVO). Young AIS-LVO patients have distinctly different underlying stroke mechanisms and etiologies. Methods: In this multicenter cohort study conducted from August 2014 to January 2020, we investigated the safety and effectiveness of EVT in young AIS-LVO patients aged≤50 years and evaluated associations between demographics, stroke etiology, neuroimaging factors and clinical outcomes, including functional outcomes, in-hospital mortality and symptomatic intracranial haemorrhage(sICH) in univariable and multivariable regression models. Results: 275 AIS-LVO patients from 10 tertiary centers in Germany, Sweden, Singapore and Taiwan were included. The more common TOAST subtypes included cardioembolism (82/275, 29.8%) and stroke of undetermined etiology (85/275, 30.9%). Arterial dissection was the most prevalent stroke etiology (42/195, 21.5%) and had the highest rate of good functional outcomes (29/42, 69.0%). Successful reperfusion was achieved in 85.1% (234/275). Excellent and good functional outcomes were achieved in 48.0% (132/275) and 66.0% (182/275) respectively. sICH occurred in 6.5% (18/275). National Institute of Health Stroke Scale (NIHSS) at presentation was inversely related with good functional outcomes (aOR0.92, 95% CI 0.88- 0.96 per point increase, p<0.001). Successful reperfusion (aOR3.22, 95% CI 1.44-7.21, p=0.005), higher ASPECTS (aOR1.21, 95% CI 1.01-1.44, p=0.036) and bridging intravenous thrombolysis (aOR2.37, 95% CI 1.29-4.34, p=0.005) independently predicted good functional outcomes. Higher initial NIHSS (aOR1.08, 95% 1.02-1.14, p=0.007) and lower ASPECTS (aOR0.73, 95% 0.58-0.93, p=0.012) were associated with sICH. Successful reperfusion was inversely associated with in-hospital mortality (aOR0.14, 95% CI 0.03-0.57, p=0.006). Hypertension strongly predicted in-hospital mortality (aOR4.59, 95% CI 1.10-19.13, p=0.036). Conclusion: While differences in functional outcomes exist across varying stroke aetiologies, high rates of successful reperfusion and good outcomes are generally achieved in young AIS-LVO patients undergoing EVT.

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