Endovascular Treatment of Acute Ischemic Stroke: A 10-year Experience from Saudi Arabia.

Background: Since 2015, endovascular therapy (EVT) has become the standard of care for acute ischemic stroke with large vessel occlusion (LVO). Objectives: To study the clinical and radiological features and outcomes of patients who underwent EVT at a tertiary care center in Saudi Arabia. Methods: This retrospective study included all patients who underwent EVT between January 2012 and December 2022 at King Abdulaziz Medical City, Riyadh. Demographic, clinical, and radiological variables were analyzed. Results: A total of 159 patients were included (males: 61%; mean age: 56.8 ± 14.1 years). Most patients had moderate (39%) to severe (45%) stroke. The commonest LVO was right middle cerebral artery (MCA; 38%), followed by left MCA (37%), and basilar artery (19%). The initial ASPECT score was 8.2 ± 1.4. The median door-to-groin time was 126 (IQR 102-152) minutes. Most (84%) received EVT within 6 hours, and intravenous tissue plasminogen activator was used in 78 (49%) patients. Successful recanalization (TICI2b and above) was achieved in 78%, with stent retriever 137 (87%) and aspiration 62 (40%) being the most common techniques. Peri-procedural complications and intraparenchymal hemorrhage were seen in 13% and 12% of the patients, respectively, while 9% required decompressive craniectomy. At discharge, 44 (28%) had modified Rankin score of 0-2; 37 (23%) died. Cardioembolic and large vessel strokes were more common in patients aged >60 years (P < 0.001). Females were more likely to have general anesthesia (P = 0.036) and require decompressive craniectomy (P = 0.003). Patients who had EVT after >6 hours were more likely to have very severe stroke (P = 0.005) and mortality (P = 0.001). Conclusions: EVT was associated with good procedural outcomes, despite slightly delayed door-to-groin time. Patients in whom EVT was initiated after >6 hours were significantly more likely to have very severe stroke and higher mortality.