Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China
Authors: Jia Baixue , Ren Zeguang , Mokin Maxim , Burgin W. Scott , Bauer Clayton T. , Fiehler Jens , Mo Dapeng , Ma Ning , Gao Feng , Huo Xiaochuan , Luo Gang , Wang Anxin , Pan Yuesong , Song Ligang , Sun Xuan , Zhang Xuelei , Gui Liqiang , Song Cunfeng , Peng Ya , Wu Jin , Zhao Shijun , Zhao Junfeng , Zhou Zhiming , Li Yongli , Jing Ping , Yang Lei , Liu Yajie , Zhao Qingshi , Liu Yan , Peng Xiaoxiang , Gao Qingchun , Guo Zaiyu , Chen Wenhuo , Li Weirong , Cheng Xiaojiang , Xu Yun , Zhang Yongqiang , Zhang Guilian , Lu Yijiu , Lu Xinyu , Wang Dengxiang , Wang Yan , Li Hao , Ling Li , Peng Guangge , Zhang Jingyu , Zhang Kai , Li Shuo , Qi Zhongqi , Xu Haifeng , Tong Xu , Ma Gaoting , Liu Raynald , Guo Xu , Deng Yiming , Leng Xinyi , Leung Thomas W. , Liebeskind David S. , Wang Yilong , Wang Yongjun , Miao Zhongrong , Hua Yang , Geng Deqin , Yuan Haicheng , Wang Hongwei , Yang Haihua , Wang Zengwu , Wei Liping , Liufu Xuancong , Shi Xiangqun , Li Juntao , Yang Wenwu , Jing Wenji , Yong Xiang , Wang Leyuan , Li Chunlei , Cao Yibin , Zhu Qingfeng , Zhang Peng , Luo Xiang , Chen Shengli , Peng WenWu , Wang Lixin , Wen Xue , Shi Shugui , Wang Wanming , Bo Wang , Yuan Pu , Wang Dong , Guan Haitao , Liang Wenbao , Ma Daliang , Chen Long , Xiao Yan , Xie Xiangdong , Shi Zhonghua , Zeng Xiangjun , Su Fanfan , Chang MingZe , Yin Jijun , Sun Hongxia , Li Chong , Bi Yong , Xie Gang , Zhao Yuwu , Wang Chao , Zhang Peng , Wang Xianjun , Li Dongqun , Liang Hui , Chen Zhonglun , Wang Yu Xin , Yin Lin , Qiu HongKai , Wei Jun , Sun Yaxuan , Feng Xiaoya , Wu Weihua , Gao Lianbo , Ai Zhibing , Lan Tan , Ding Li , Liang Qilong , Wang Zhimin , Yang Jianwen , Xu Ping , Dong Wei , Zheng Quanle , Zhu Zhenyun , Zhao Liyue , Meng Qingbo , Wei Yuqing , Chen Xianglin , Wang Wei , Sun Dong , Yan Yongxing , Yuan Guangxiong , Yang Yadong , Zhou Jianfeng , Yang Zhi , Zhang Zhenzhong , Guan Ning , Wang Huihong 
Published: February 2021

Background and Purpose:

The benefit of endovascular treatment (EVT) for large vessel occlusion in clinical practice in developing countries like China needs to be confirmed. The aim of the study was to determine whether the benefit of EVT for acute ischemic stroke in randomized trials could be generalized to clinical practice in Chinese population.

Methods:

We conducted a prospective registry of EVT at 111 centers in China. Patients with acute ischemic stroke caused by imaging-confirmed intracranial large vessel occlusion and receiving EVT were included. The primary outcome was functional independence at 90 days defined as a modified Rankin Scale score of 0 to 2. Outcomes of specific subgroups in the anterior circulation were reported and logistic regression was performed to predict the primary outcome.

Results:

Among the 1793 enrolled patients, 1396 (77.9%) had anterior circulation large vessel occlusion (median age, 66 [56–73] years) and 397 (22.1%) had posterior circulation large vessel occlusion (median age, 64 [55–72] years). Functional independence at 90 days was reached in 45% and 44% in anterior and posterior circulation groups, respectively. For anterior circulation population, underlying intracranial atherosclerotic disease was identified in 29% of patients, with higher functional independence at 90 days (52% versus 44%;
P
=0.0122) than patients without intracranial atherosclerotic disease. In the anterior circulation population, after adjusting for baseline characteristics, procedure details, and early outcomes, the independent predictors for functional independence at 90 days were age <66 years (odds ratio [OR], 1.733 [95% CI, 1.213–2.476]), time from onset to puncture >6 hours (OR, 1.536 [95% CI, 1.065–2.216]), local anesthesia (OR, 2.194 [95% CI, 1.325–3.633]), final modified Thrombolysis in Cerebral Infarction 2b/3 (OR, 2.052 [95% CI, 1.085–3.878]), puncture-to-reperfusion time ≤1.5 hours (OR, 1.628 [95% CI, 1.098–2.413]), and National Institutes of Health Stroke Scale score 24 hours after the procedure <11 (OR, 9.126 [95% CI, 6.222–13.385]).

Conclusions:

Despite distinct characteristics in the Chinese population, favorable outcome of EVT can be achieved in clinical practice in China.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03370939.