Effectiveness of combined reperfusion therapy in patients with cerebral infarction

Objective. To analyze effectiveness of combined reperfusion therapy (RT) in patients with cerebral infarction (CI) based on registry data of Neurology Department No. 1 of the Gomel University Clinic – Regional Hospital for Veterans of the Great Patriotic War over 2024.

Materials and methods. A retrospective analysis of 30 cases of CI in patients treated at the Gomel University Clinic over 2024 was conducted. 12 women and 18 men, average age is 69 [62; 74] years old were involved. All patients underwent a somatic and neurological examination, clinical tests, functional status assessment, computed tomography was performed, and IM subtype was determined according to the TOAST. The National Institutes of Health Stroke Scale (NIHSS) score was assessed before conducting systemic thrombolytic therapy and after RT. Time intervals for providing assistance were defined for each patient: “from onset to door”, “from door to needle”, “from door to puncture”. Blood flow recovery was assessed using the Thrombosis in Cerebral Infarction (TICI) scale. Treatment outcomes were assessed at the end of the acute period. The data were analyzed using STATISTICA 10.0, R language.

Results. The age of patients underwent RT was: 75 [71.3; 83] years old in women and 64 [56; 69] years old in men, p<0.001. The predominant pathogenetic subtype was atherothrombotic in men — 90%, p=0.046, cardioembolic in women — 42%, p=0.017. The time parameters of reperfusion complied with the national requirements: 93 [65; 110] minutes “from onset to door”; 35 [25; 110] minutes from door to needle; 97.5 [82; 140] minutes “from door to puncture”. Time intervals did not differ in patients with different CI outcomes. Satisfactory reperfusion percent was 68% > 2 points on the TICI scale, mortality after RT was 16%. The outcome of CI after RT was influenced by NIHSS score on admission: OR=1.54, 𝜒²=6.34, p=0.012.

Conclusion. Satisfactory results of RT application within the Neurology Department No. 1 of the Gomel University Clinic – Regional Hospital for Veterans of the Great Patriotic War were identified, with mortality lower than the literature data (16% versus 19%). The factors, correction of which can potentially improve the outcome of CI, were identified.

1. GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:439-458. DOI: https://doi.org/10.1016/S1474-4422(19)30034-1

2. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke. Stroke. 2019;50:e344-e418. DOI: https://doi.org/10.1161/STR.0000000000000211

3. Xiong Y, Chen HS, Wang AM, Wang Y, Pan Y, Liu L, et al. Rationale and design of tenecteplase reperfusion therapy in acute ischaemic cerebrovascular events III (TRACE III): a randomised, phase III, open-label, controlled trial. Stroke Vasc Neurol. 2024;9:e002310. DOI: https://doi.org/10.1136/svn-2023-002310

4. Fan S, Wang Y, Hao Y, Liu L. Reperfusion therapy for acute ischemic stroke: where we are and where to go. J Transl Intern Med. 2025;13:1-3. DOI: https://doi.org/10.1515/jtim-2025-0001

5. Fransen PS, Beumer D, Berkhemer OA, et al. MR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands: study protocol for a randomized controlled trial. Trials. 2014;15:343. DOI: https://doi.org/10.1186/1745-6215-15-343

6. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a metaanalysis of individual patient data from five randomised trials. Lancet. 2016;387:1723-1731. DOI: https://doi.org/10.1016/S0140-6736(16)00163-X

7. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11-21. DOI: https://doi.org/10.1056/NEJMoa1706442

8. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378:708-718. DOI: https://doi.org/10.1056/NEJMoa1713973

9. MacKenzie IER, Moeini-Naghani I, Sigounas D, et al. Trends in endovascular mechanical thrombectomy in treatment of acute ischemic stroke in the United States. World Neurosurg. 2020;138:e839-e846.

10. Kim J, Easton D, Zhao H, et al. Global stroke statistics 2023: availability of reperfusion services around the world. Int J Stroke. 2023;19:259-269. DOI: https://doi.org/10.1177/1747493023121044

11. Campbell BCV. Hyperacute ischemic stroke care— current treatment and future directions. Int J Stroke. 2024;19:755- 762. DOI: https://doi.org/10.1177/17474930241239119

12. Meretja A, Keshtkaran A, Saver JL, et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA. 2013;309:2480-2485. DOI: https://doi.org/10.1001/jama.2013.6959

13. Saver JL, Goyal M, van der Lugt A, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016;316:1279-1288. DOI: https://doi.org/10.1001/jama.2016.13647

14. Mujanovic A, Strbian D, Demeestere J, Marto JP, Puetz V, Nogueira RG, Abdalkader M, et al. Safety and clinical outcomes of endovascular therapy versus medical management in late presentation of large ischemic stroke. Eur Stroke J. 2024;9:908-919. DOI: https://doi.org/10.1177/23969873241249406