Peter Vanacker1, Dimitris Lambrou2, Ashraf Eskandari2, George Ntaios3, Patrick Cras4, Philippe Maeder5, Reto Meuli5, Patrik Michel2. 1. Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Department of Neurology, University Hospital Antwerp, Edegem, Belgium. Electronic address: peter.vanacker@chuv.ch. 2. Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 3. Department of Medicine, University of Thessaly, Larissa, Greece. 4. Department of Neurology, University Hospital Antwerp, Edegem, Belgium. 5. Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Abstract
BACKGROUND: Endovascular treatment for acute ischemic stroke patients was recently shown to improve recanalization rates and clinical outcome in a well-defined study population. Intravenous thrombolysis (IVT) alone is insufficiently effective to recanalize in certain patients or of little value in others. Accordingly, we aimed at identifying predictors of recanalization in patients treated with or without IVT. METHODS: In the observational Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry, we selected those stroke patients (1) with an arterial occlusion on computed tomography angiography (CTA) imaging, (2) who had an arterial patency assessment at 24 hours (CTA/magnetic resonance angiography/transcranial Doppler), and (3) who were treated with IVT or had no revascularization treatment. Based on 2 separate logistic regression analyses, predictors of spontaneous and post-thrombolytic recanalization were generated. RESULTS: Partial or complete recanalization was achieved in 121 of 210 (58%) thrombolyzed patients. Recanalization was associated with atrial fibrillation (odds ratio , 1.6; 95% confidence interval, 1.2-3.0) and absence of early ischemic changes on CT (1.1, 1.1-1.2) and inversely correlated with the presence of a significant extracranial (EC) stenosis or occlusion (.6, .3-.9). In nonthrombolyzed patients, partial or complete recanalization was significantly less frequent (37%, P < .01). The recanalization was independently associated with a history of hypercholesterolemia (2.6, 1.2-5.6) and the proximal site of the intracranial occlusion (2.5, 1.2-5.4), and inversely correlated with a decreased level of consciousness (.3, .1-.8), and EC (.3, .1-.6) and basilar artery pathology (.1, .0-.6). CONCLUSIONS: Various clinical findings, cardiovascular risk factors, and arterial pathology on acute CTA-based imaging are moderately associated with spontaneous and post-thrombolytic arterial recanalization at 24 hours. If confirmed in other studies, this information may influence patient selection toward the most appropriate revascularization strategy.
BACKGROUND: Endovascular treatment for acute ischemic strokepatients was recently shown to improve recanalization rates and clinical outcome in a well-defined study population. Intravenous thrombolysis (IVT) alone is insufficiently effective to recanalize in certain patients or of little value in others. Accordingly, we aimed at identifying predictors of recanalization in patients treated with or without IVT. METHODS: In the observational Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry, we selected those strokepatients (1) with an arterial occlusion on computed tomography angiography (CTA) imaging, (2) who had an arterial patency assessment at 24 hours (CTA/magnetic resonance angiography/transcranial Doppler), and (3) who were treated with IVT or had no revascularization treatment. Based on 2 separate logistic regression analyses, predictors of spontaneous and post-thrombolytic recanalization were generated. RESULTS: Partial or complete recanalization was achieved in 121 of 210 (58%) thrombolyzed patients. Recanalization was associated with atrial fibrillation (odds ratio , 1.6; 95% confidence interval, 1.2-3.0) and absence of early ischemic changes on CT (1.1, 1.1-1.2) and inversely correlated with the presence of a significant extracranial (EC) stenosis or occlusion (.6, .3-.9). In nonthrombolyzed patients, partial or complete recanalization was significantly less frequent (37%, P < .01). The recanalization was independently associated with a history of hypercholesterolemia (2.6, 1.2-5.6) and the proximal site of the intracranial occlusion (2.5, 1.2-5.4), and inversely correlated with a decreased level of consciousness (.3, .1-.8), and EC (.3, .1-.6) and basilar artery pathology (.1, .0-.6). CONCLUSIONS: Various clinical findings, cardiovascular risk factors, and arterial pathology on acute CTA-based imaging are moderately associated with spontaneous and post-thrombolytic arterial recanalization at 24 hours. If confirmed in other studies, this information may influence patient selection toward the most appropriate revascularization strategy.
Authors: Laura Heitsch; Laura Ibanez; Caty Carrera; Michael M Binkley; Daniel Strbian; Turgut Tatlisumak; Alejandro Bustamante; Marc Ribó; Carlos Molina; Antoni Dávalos; Elena López-Cancio; Lucia Muñoz-Narbona; Carol Soriano-Tárraga; Eva Giralt-Steinhauer; Victor Obach; Agnieszka Slowik; Joanna Pera; Katarzyna Lapicka-Bodzioch; Justyna Derbisz; Tomás Sobrino; José Castillo; Francisco Campos; Emilio Rodríguez-Castro; Susana Arias-Rivas; Tomas Segura; Gemma Serrano-Heras; Cristófol Vives-Bauza; Rosa Díaz-Navarro; Silva Tur; Carmen Jimenez; Joan Martí-Fàbregas; Raquel Delgado-Mederos; Juan Arenillas; Jerzy Krupinski; Natalia Cullell; Nuria P Torres-Aguila; Elena Muiño; Jara Cárcel-Márquez; Francisco Moniche; Juan A Cabezas; Andria L Ford; Rajat Dhar; Jaume Roquer; Pooja Khatri; Jordi Jiménez-Conde; Israel Fernandez-Cadenas; Joan Montaner; Jonathan Rosand; Carlos Cruchaga; Jin-Moo Lee Journal: Stroke Date: 2020-12-15 Impact factor: 7.914
Authors: Senna Staessens; Frederik Denorme; Olivier Francois; Linda Desender; Tom Dewaele; Peter Vanacker; Hans Deckmyn; Karen Vanhoorelbeke; Tommy Andersson; Simon F De Meyer Journal: Haematologica Date: 2020-01-31 Impact factor: 9.941