Clinical characteristics and outcomes of mechanical thrombectomy in acute ischemic stroke: a cross-sectional study with subgroup analysis.

BACKGROUND

Mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion. However, evidence remains limited in patients outside top-tier recommendation criteria, particularly in medium-vessel occlusions, tandem occlusions, and posterior circulation strokes.

METHODS

We conducted a retrospective, cross-sectional study of consecutive patients with AIS treated with MT at a tertiary hospital between 2012 and 2022. Clinical, radiological, and procedural data were collected. Patients were stratified according to class of recommendation, vascular territory, and occlusion segment. A favorable functional outcome was defined as a modified Rankin Scale score of 0-2 at 90 days.

RESULTS

A total of 334 patients were included (mean age 67.7±13.8 years; 52.7% women), of whom 146 (43.7%) met high-level recommendation criteria for MT. Cardioembolic etiology was the most frequent (47.6%), whereas atherosclerosis predominated in tandem occlusions. Successful recanalization was achieved in 80.3% of cases, without significant differences across subgroups. Symptomatic intracranial hemorrhage occurred in 11% of patients. Ninety-day mortality was 22.1%, reaching 34.6% in posterior circulation strokes. Overall, 58.2% of patients achieved a favorable functional outcome at 90 days, with the highest rates observed in M2 segment occlusions of the middle cerebral artery (73.5%).

CONCLUSION

MT for AIS was safe and effective across a broad range of occlusion locations, including patients outside high-level evidence criteria. These findings suggest the need for studies evaluating broader clinical profiles.