J D Fields1, H L Lutsep, W S Smith. 1. Department of Interventional Neuroradiology, Oregon Health and Science University, Portland, OR 97239, USA. fieldsje@ohsu.edu
Abstract
BACKGROUND AND PURPOSE: Although the combined end point of partial and complete recanalization is a well-established predictor of good outcome following acute stroke intervention, few investigations have evaluated the effect of the degree of recanalization. We hypothesized that greater degrees of recanalization would be associated with a higher likelihood of favorable functional outcomes. MATERIALS AND METHODS: Data from MERCI and Multi MERCI-prospective single-arm trials of endovascular mechanical thrombectomy for acute stroke-were pooled. The TIMI score was used to define the degree of recanalization, and a favorable outcome was defined as an mRS score of 0-2 at 90 days. RESULTS: A total of 305 patients were included. Age, stroke severity, and site of arterial occlusion did not differ among groups stratified by the TIMI score. The unadjusted OR for a favorable outcome increased significantly as the TIMI score increased from 0 to 1 (OR, 5.9; 95% CI, 1.7-20.0; P = .007) and from 2 to 3 (OR. 2.3; 95% CI, 1.2-4.5; P = .01) and the likelihood of death decreased significantly as the TIMI score increased from 2 to 3 (OR, 2.2; 95% CI, 1.1-4.3; P = .05). In multivariate analysis, each increase in TIMI grade increased the odds of a good outcome 2.6-fold (95% CI, 1.9-3.4, P < .0001). CONCLUSIONS: Increases in the TIMI score were highly associated with improved outcomes. This finding not only provides additional evidence that restoration of blood flow improves clinical outcomes in ischemic stroke but also suggests that interventionalists should strive for complete revascularization when they provide endovascular treatment for acute ischemic stroke.
BACKGROUND AND PURPOSE: Although the combined end point of partial and complete recanalization is a well-established predictor of good outcome following acute stroke intervention, few investigations have evaluated the effect of the degree of recanalization. We hypothesized that greater degrees of recanalization would be associated with a higher likelihood of favorable functional outcomes. MATERIALS AND METHODS: Data from MERCI and Multi MERCI-prospective single-arm trials of endovascular mechanical thrombectomy for acute stroke-were pooled. The TIMI score was used to define the degree of recanalization, and a favorable outcome was defined as an mRS score of 0-2 at 90 days. RESULTS: A total of 305 patients were included. Age, stroke severity, and site of arterial occlusion did not differ among groups stratified by the TIMI score. The unadjusted OR for a favorable outcome increased significantly as the TIMI score increased from 0 to 1 (OR, 5.9; 95% CI, 1.7-20.0; P = .007) and from 2 to 3 (OR. 2.3; 95% CI, 1.2-4.5; P = .01) and the likelihood of death decreased significantly as the TIMI score increased from 2 to 3 (OR, 2.2; 95% CI, 1.1-4.3; P = .05). In multivariate analysis, each increase in TIMI grade increased the odds of a good outcome 2.6-fold (95% CI, 1.9-3.4, P < .0001). CONCLUSIONS: Increases in the TIMI score were highly associated with improved outcomes. This finding not only provides additional evidence that restoration of blood flow improves clinical outcomes in ischemic stroke but also suggests that interventionalists should strive for complete revascularization when they provide endovascular treatment for acute ischemic stroke.
Authors: T G Jovin; R Gupta; M B Horowitz; S Z Grahovac; C A Jungreis; L Wechsler; J M Gebel; H Yonas Journal: AJNR Am J Neuroradiol Date: 2007-01 Impact factor: 3.825
Authors: Caspar Brekenfeld; Luca Remonda; Krassen Nedeltchev; Ferdinand v Bredow; Christoph Ozdoba; Roland Wiest; Marcel Arnold; Heinrich P Mattle; Gerhard Schroth Journal: Neurol Res Date: 2005 Impact factor: 2.448
Authors: Maher Saqqur; Ken Uchino; Andrew M Demchuk; Carlos A Molina; Zsolt Garami; Sergio Calleja; Naveed Akhtar; Finton O Orouk; Abdul Salam; Ashfaq Shuaib; Andrei V Alexandrov Journal: Stroke Date: 2007-02-08 Impact factor: 7.914
Authors: Wade S Smith; Gene Sung; Jeffrey Saver; Ronald Budzik; Gary Duckwiler; David S Liebeskind; Helmi L Lutsep; Marilyn M Rymer; Randall T Higashida; Sidney Starkman; Y Pierre Gobin; Donald Frei; Thomas Grobelny; Frank Hellinger; Dan Huddle; Chelsea Kidwell; Walter Koroshetz; Michael Marks; Gary Nesbit; Isaac E Silverman Journal: Stroke Date: 2008-02-28 Impact factor: 7.914
Authors: Michael P Marks; Maarten G Lansberg; Michael Mlynash; Stephanie Kemp; Ryan A McTaggart; Greg Zaharchuk; Roland Bammer; Gregory W Albers Journal: Int J Stroke Date: 2014-03-31 Impact factor: 5.266
Authors: Jens Fiehler; Michael Söderman; Francis Turjman; Philip M White; Søren Jacob Bakke; Salvatore Mangiafico; Rüdiger von Kummer; Mario Muto; Christophe Cognard; Jan Gralla Journal: Neuroradiology Date: 2012-09-05 Impact factor: 2.804
Authors: Michael T Froehler; Satoshi Tateshima; Gary Duckwiler; Reza Jahan; Nestor Gonzalez; Fernando Vinuela; David Liebeskind; Jeffrey L Saver; J Pablo Villablanca Journal: J Neurointerv Surg Date: 2012-05-22 Impact factor: 5.836
Authors: Jinhao Lyu; Ning Ma; David S Liebeskind; Danny J J Wang; Lin Ma; Yang Xu; Ting Wang; Zhongrong Miao; Xin Lou Journal: Stroke Date: 2016-01-05 Impact factor: 7.914