Objective To investigate the clinical efficacy of endovascular thrombectomy in patients with acute anterior circulation stroke with large vessel occlusion beyond the time window. Methods From January 2014 to September 2018,182 patients with acute anterior circulation stroke with large vessel occlusion and treated with endovascular thrombectomy in the Department of Neurology of Liuzhou People's Hospital were retrospectively included. Preoperative CT angiography or MR angiography confirmed the presence of internal carotid artery or middle cerebral artery occlusion. According to the symptom onset to puncture (OTP) time, patients were divided into the within time windov group(0TP^6 h, 156 cases) and the beyond lime window group (OTP >6 h,26 eases). Data collected and analyzed between the two groups included age, gender, cerebrovascular disease risk factors, emergency blood glucose, the United Stales .National Institutes of Health Stroke Scale( MUSS) score,stroke etiology classification, Albena Stroke Program Early CT( ASPECT) score,the American Society of Interventional and Therapeutic Ncuroradiology/Society of Interventional Radiology (ASITN/S1H) scale, occlusion site, intravenous thrombolysis ratio, imaging data.operation lime node,number of thrombectomy,remedy treatment and recanalizalion. Also, complications and clinical prognosis of the two groups v»cre evaluated. 'Hie successful recanalizalion was defined as modified thrombolysis in cerebral infarction (mTICl) 2li or 3. According to the 90 d modified Rankin scale (mKS) score,0-2 was considered as favorable outcome,and 6 was considered as death. Results (I )No significant difference∗ were between the two groups in age,gender .hypertension,atrial fibrilUliu:i,hyj>erlipidcmia,diabetes, history of cerebral infarction,smoking history,baseline N1HSS score. ASPECT score, Wood glucose level, occlusions site and AS1TN/SIR scale0-1 (all I' >0.05). The intravenous thrombolysis proportion in the within time window group was higher than that in the beyond time window group,and the difference was statistically significant (38.5<∗ (60/156 J «. 11.5%[3/26] rf = 7. 137,/'= 0.OOS). (2) Tbere were no statistically significant differences in etiology classification, time from OTP to recanalizatkm, number of thrombectomy,mTICl 2b-3 and remedial treatment between the two groups (all >0. 05). In the within timr window group,llie time from symptom onset to imaging examination ( 146[ 110.229] min a. 307(234, 349] min./f a-5.182) .the timr fromsymptom OTP (240[ 190,298] min w.395(379.533] nin,Z=-8.015), and the time from symptom onset to recanalizalion (329(281,3X8] min 1x492(442.567] min,/=-6.618) were idl significantly shorter than those in the beyond lime window group (all P <0. 01). (3) There was no statistically significant difference in the incidence of symptomatic intracranial hemorrhage and asymptomatic intracranial hemoahagc 24 hours after operation between the two groups (Ixiih P > 0.05 ). After 3 months of follow-up,there was no statistically significant difference in the proportion of favorable outcome and mortality ljetwren the two groups (both/' > 0.05). Conclusion Intravascular thrombectomy for acute anterior circulation stroke with large vessel occlusion beyond the lime window has comparably good prognosis with that of patients within the lime window, without increasing tl>e 90 <1 incidence of symptomatic intracranial hemoahagc and mortality.

Objective:To compare the clinical effects of direct mechanical thrombectomy (MT) and intravenous thrombolysis (IVT) bridging MT (IVT+ MT) in the treatment of patients with acute anterior circulation large vessel occlusive stroke with high clot burden.Methods:Consecutive patients with acute anterior circulation large vessel occlusion with clot burden score ≤6 admitted to the Department of Neurology, Liuzhou People's Hospital and received endovascular treatment (MT or IVT+ MT) from June 2015 to April 2019 were enrolled retrospectively. The baseline clinical data, surgical status, clinical outcome, length of stay and cost of hospitalization in the direct MT group and the IVT+ MT group were compared. The modified Rankin Scale was used to evaluate the outcomes at 90 d after the onset of stroke. 0-2 was defined as a good outcome and >2 was defined as a poor outcome. Multivariate logistic regression analysis was used to identify the independent influencing factors of poor outcomes. Results:A total of 115 patients with acute anterior circulation large vascular occlusive stroke with high clot burden were enrolled, aged 65.4±12.0 years, 70 (60.9%) were male. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 18.0 (14.0-22.0). Seventy patients (60.9%) in the direct MT group, 45 in the IVT+ MT group (39.1%). Forty-nine patients (42.6%) had a good outcome and 66 (57.4%) had a poor outcome. The time from onset to inguinal puncture (210 [130-255] min vs. 230 [187-268] min; Z=-1.982, P=0.047) and the time from onset to successful vascular recanalization (283 [228-358] min vs. 320 [268-385] min; Z=-2.017, P=0.044) were significantly shorter than the IVT+ MT group, but there were no significant differences in the successful recanalization rate (84.4% vs. 81.4%; χ2=0.173, P=0.677), the incidence of postoperative symptomatic intracranial hemorrhage (6.7% vs. 7.1%; P=1.000) and the good outcome rate at 90 d (40.0% vs. 44.3%; χ2=0.206, P=0.650) between the direct MT group and the IVT+ MT group. In addition, although there was no significant difference in length of stay between the two groups (12.1±7.1 d vs. 10.6±6.6 d; t=1.128, P=0.262), the total hospitalization cost of the direct MT group was significantly lower than that of the IVT+ MT group (80 328 [63 214-101 136] CNY vs. 88 517 [68 001-115 590] CNY; Z=-1.972, P=0.049). Multivariate logistic regression analysis showed that higher baseline systolic blood pressure (odds ratio [ OR] 1.033, 95% confidence interval [ CI] 1.005-1.062; P=0.019), higher baseline NIHSS score ( OR 1.117, 95% CI 1.029-1.213; P=0.008) and lower baseline Alberta Stroke Program Early CT Score ( OR 0.189, 95% CI 0.056-0.641; P=0.008) were independently associated with the poor outcomes, while there was no independent correlation between the endovascular treatment mode and the outcomes. Conclusions:For patients with anterior circulation large vessel occlusive stroke with high clot burden, the successful recanalization rate and good clinical outcome rate of direct MT were equivalent to IVT+ MT, but the cost was less. Therefore, direct MT may be a better choice for the treatment of anterior circulation large vessel occlusive stroke with high clot burden.