Anselm Angermaier1, Patrik Michel2, Alexander V Khaw3, Michael Kirsch4, Christof Kessler5, Soenke Langner4. 1. Department of Neurology, University Medicine Greifswald, Greifswald, Germany. Electronic address: anselm.angermaier@uni-greifswald.de. 2. Stroke Center, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Lausanne, Switzerland. 3. Department of Neurology, University Medicine Greifswald, Greifswald, Germany; Department of Clinical Neurosciences, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada. 4. Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany. 5. Department of Neurology, University Medicine Greifswald, Greifswald, Germany.
Abstract
BACKGROUND: Patient selection for endovascular revascularization treatment (ERT) in acute ischemic stroke depends on the expected benefit-risk ratio. As rapid revascularization is a major determinant of good functional outcome, we aimed to identify its predictors after ERT. METHODS: Consecutive stroke patients from a single stroke center with distal internal carotid artery-, proximal middle cerebral artery- or T-occlusions treated with ERT were retrospectively selected. We assessed admission noncontrast computed tomography and computed tomography angiography for thrombus location, thrombus load (clot burden score), and collateral status. Clinical data were extracted from medical charts. Univariate and multivariate regression analyses were performed to identify predictors of revascularization (thrombolysis in cerebral infarction ≥2b) after ERT. RESULTS: A total of 63 patients were identified (median age, 73 years; interquartile range: 62-77; 40 females). Sixteen patients (25.4%) underwent intravenous thrombolysis (ivT) before ERT. Twenty-two patients (34.9%) had additional intra-arterial application of recombinant tissue plasminogen activator. The overall recanalization rate was 66.7%, and 9.5% had symptomatic intracranial bleeding. In-hospital mortality was 15%, and 30% reached good functional outcome at discharge. In the univariate analysis, preceding ivT and the number of passes for thrombectomy (dichotomized ≤2 versus >2) were associated with recanalization. There was a trend for number of thrombectomy passes (as continuous variable) and multimodal ERT. In the multivariate regression analysis, ivT prior to ERT and passes of thrombectomy were identified as independent predictors for recanalization. CONCLUSION: ivT and lower passes of thrombectomy are associated with recanalization after ERT for ischemic stroke with proximal vessel occlusions.
BACKGROUND:Patient selection for endovascular revascularization treatment (ERT) in acute ischemic stroke depends on the expected benefit-risk ratio. As rapid revascularization is a major determinant of good functional outcome, we aimed to identify its predictors after ERT. METHODS: Consecutive strokepatients from a single stroke center with distal internal carotid artery-, proximal middle cerebral artery- or T-occlusions treated with ERT were retrospectively selected. We assessed admission noncontrast computed tomography and computed tomography angiography for thrombus location, thrombus load (clot burden score), and collateral status. Clinical data were extracted from medical charts. Univariate and multivariate regression analyses were performed to identify predictors of revascularization (thrombolysis in cerebral infarction ≥2b) after ERT. RESULTS: A total of 63 patients were identified (median age, 73 years; interquartile range: 62-77; 40 females). Sixteen patients (25.4%) underwent intravenous thrombolysis (ivT) before ERT. Twenty-two patients (34.9%) had additional intra-arterial application of recombinant tissue plasminogen activator. The overall recanalization rate was 66.7%, and 9.5% had symptomatic intracranial bleeding. In-hospital mortality was 15%, and 30% reached good functional outcome at discharge. In the univariate analysis, preceding ivT and the number of passes for thrombectomy (dichotomized ≤2 versus >2) were associated with recanalization. There was a trend for number of thrombectomy passes (as continuous variable) and multimodal ERT. In the multivariate regression analysis, ivT prior to ERT and passes of thrombectomy were identified as independent predictors for recanalization. CONCLUSION: ivT and lower passes of thrombectomy are associated with recanalization after ERT for ischemic stroke with proximal vessel occlusions.
Authors: Philipp Bücke; Marta Aguilar Pérez; Elisabeth Schmid; Christian H Nolte; Hansjörg Bäzner; Hans Henkes Journal: Clin Neuroradiol Date: 2017-01-31 Impact factor: 3.649
Authors: Huu An Nguyen; Dang Luu Vu; Quang Anh Nguyen; Duy Ton Mai; Anh Tuan Tran; Hoang Kien Le; Tat Thien Nguyen; Thu Trang Nguyen; Cuong Tran; Viet Phuong Dao; Laurent Pierot Journal: Front Neurol Date: 2022-06-30 Impact factor: 4.086