Min Uk Jang1, Jeong-Ho Hong2, Jihoon Kang2, Beom Joon Kim2, Moon-Ku Han2, Byung-Chul Lee3, Kyung-Ho Yu3, Mi Sun Oh3, Keun-Sik Hong4, Yong-Jin Cho4, Jong-Moo Park5, Kyusik Kang5, Jae Kwan Cha6, Dae-Hyun Kim6, Tai Hwan Park7, Kyung Bok Lee8, Soo Joo Lee9, Youngchai Ko9, Jun Lee10, Ki-Hyun Cho11, Joon-Tae Kim11, Juneyoung Lee12, Ji Sung Lee13, Hee-Joon Bae14. 1. Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon, Korea. 2. Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea. 3. Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea. 4. Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea. 5. Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea. 6. Department of Neurology, Dong-A University Hospital, Pusan, Korea. 7. Department of Neurology, Seoul Medical Center, Seoul, Korea. 8. Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea. 9. Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea. 10. Department of Neurology, Yeungnam University Medical Center, Daegu, Korea. 11. Department of Neurology, Chonnam National University Hospital, Gwangju, Korea. 12. Department of Biostatistics, Korea University College of Medicine, Seoul, Korea. 13. Biostatistical Consulting Unit, Soonchunhyang University Medical Center of Biostatistics, Seoul, Korea. 14. Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea. Electronic address: braindoc@snu.ac.kr.
Abstract
BACKGROUND: Recent methodological advances in recanalization therapy may alter recanalization strategies and clinical outcomes in patients with symptomatic occlusion of intracranial cerebral arteries. However, few studies have analyzed these changes at a national level, with none conducted in Korea. METHODS: On the basis of a prospective multicenter stroke registry database in Korea, 642 consecutive patients hospitalized within 12 hours of the onset with symptomatic occlusion of intracranial major cerebral arteries between March 2010 and November 2011 were identified. Recanalization therapy was used in 48% (n = 307) of patients; intravenous thrombolysis only (IVT) in 46%, intra-arterial thrombolysis only (IAT) in 16%, and combined thrombolysis (CMT) in 38%. Of the 166 patients treated by IAT or CMT, the Penumbra system or the Solitaire was used in 58% of patients. RESULTS: Early neurologic improvement (ENI), 3-month modified Rankin scale (mRS) score of 2 or less, and symptomatic hemorrhagic transformation (SHT) were observed in 43%, 39%, and 9% of the patients in the IVT group; 52%, 27%, and 12% of the patients in the IAT group; and 54%, 39%, and 12% of the patients in the CMT group, respectively. Compared with no treatment, adjusted odd ratios (95% confidence intervals) of recanalization therapy were 1.59 (1.04-2.42) for ENI, 1.37 (.81-2.30) for 3-month mRS score of 2 or less, and 2.58 (1.12-5.91) for SHT. CONCLUSIONS: The variety and active use of endovascular approaches were quite noticeable. As a whole, recanalization therapy tended to contribute to favorable outcomes despite a significant increase of symptomatic hemorrhage.
BACKGROUND: Recent methodological advances in recanalization therapy may alter recanalization strategies and clinical outcomes in patients with symptomatic occlusion of intracranial cerebral arteries. However, few studies have analyzed these changes at a national level, with none conducted in Korea. METHODS: On the basis of a prospective multicenter stroke registry database in Korea, 642 consecutive patients hospitalized within 12 hours of the onset with symptomatic occlusion of intracranial major cerebral arteries between March 2010 and November 2011 were identified. Recanalization therapy was used in 48% (n = 307) of patients; intravenous thrombolysis only (IVT) in 46%, intra-arterial thrombolysis only (IAT) in 16%, and combined thrombolysis (CMT) in 38%. Of the 166 patients treated by IAT or CMT, the Penumbra system or the Solitaire was used in 58% of patients. RESULTS: Early neurologic improvement (ENI), 3-month modified Rankin scale (mRS) score of 2 or less, and symptomatic hemorrhagic transformation (SHT) were observed in 43%, 39%, and 9% of the patients in the IVT group; 52%, 27%, and 12% of the patients in the IAT group; and 54%, 39%, and 12% of the patients in the CMT group, respectively. Compared with no treatment, adjusted odd ratios (95% confidence intervals) of recanalization therapy were 1.59 (1.04-2.42) for ENI, 1.37 (.81-2.30) for 3-month mRS score of 2 or less, and 2.58 (1.12-5.91) for SHT. CONCLUSIONS: The variety and active use of endovascular approaches were quite noticeable. As a whole, recanalization therapy tended to contribute to favorable outcomes despite a significant increase of symptomatic hemorrhage.