Mònica Millán1, Sebastià Remollo2, Helena Quesada2, Arturo Renú2, Alejandro Tomasello2, Priyanka Minhas2, Natalia Pérez de la Ossa2, Marta Rubiera2, Laura Llull2, Pedro Cardona2, Fahad Al-Ajlan2, María Hernández2, Zarina Assis2, Andrew M Demchuk2, Tudor Jovin2, Antoni Dávalos2. 1. From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.). mmillan.germanstrias@gencat.cat. 2. From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
Abstract
BACKGROUND AND PURPOSE: Higher rates of target vessel patency at 24 hours were noted in the thrombectomy group compared with control group in recent randomized trials. As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as they related to clinical outcome and 24-hour infarct volume in REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset). METHODS: Independent core laboratory adjudicated vessel status according to modified arterial occlusive lesion classification at 24 hours on computed tomographic/magnetic resonance (94.2%/5.8%) angiography and 24-hour infarct volume on computed tomography were studied (95/103 patients in the thrombectomy group versus 94/103 in the control group, respectively). Complete revascularization was defined as modified arterial occlusive lesion grade 3. Its effect on clinical outcome was analyzed by ordinal logistic regression. RESULTS:Complete revascularization was achieved in 70.5% of the solitaire group and in 22.3% of the control group (P<0.001). Significant differences in complete revascularization rates were found for terminus internal carotid artery, M1, and tandem occlusions (all P<0.001) but not for M2 occlusions. In the thrombectomy group, 2 out of 63 patients (3.1%) with modified Thrombolysis in Cerebral Infarction 2b/3 after thrombectomy showed arterial reocclusion (modified arterial occlusive lesion grade 0/1) at 24 hours. Complete revascularization was associated with improved outcome in both thrombectomy (adjusted odds ratio, 4.5; 95% confidence interval, 1.9-10.9) and control groups (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-6.7). Revascularization (modified arterial occlusive lesion grade 2/3) was associated with smaller infarct volumes in either treatment arm. CONCLUSIONS:Complete revascularization at 24 hours is a powerful predictor of favorable clinical outcome, whereas revascularization of any type results in reduced infarct volume in both thrombectomy and control groups. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01692379.
RCT Entities:
BACKGROUND AND PURPOSE: Higher rates of target vessel patency at 24 hours were noted in the thrombectomy group compared with control group in recent randomized trials. As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as they related to clinical outcome and 24-hour infarct volume in REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset). METHODS: Independent core laboratory adjudicated vessel status according to modified arterial occlusive lesion classification at 24 hours on computed tomographic/magnetic resonance (94.2%/5.8%) angiography and 24-hour infarct volume on computed tomography were studied (95/103 patients in the thrombectomy group versus 94/103 in the control group, respectively). Complete revascularization was defined as modified arterial occlusive lesion grade 3. Its effect on clinical outcome was analyzed by ordinal logistic regression. RESULTS: Complete revascularization was achieved in 70.5% of the solitaire group and in 22.3% of the control group (P<0.001). Significant differences in complete revascularization rates were found for terminus internal carotid artery, M1, and tandem occlusions (all P<0.001) but not for M2 occlusions. In the thrombectomy group, 2 out of 63 patients (3.1%) with modified Thrombolysis in Cerebral Infarction 2b/3 after thrombectomy showed arterial reocclusion (modified arterial occlusive lesion grade 0/1) at 24 hours. Complete revascularization was associated with improved outcome in both thrombectomy (adjusted odds ratio, 4.5; 95% confidence interval, 1.9-10.9) and control groups (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-6.7). Revascularization (modified arterial occlusive lesion grade 2/3) was associated with smaller infarct volumes in either treatment arm. CONCLUSIONS: Complete revascularization at 24 hours is a powerful predictor of favorable clinical outcome, whereas revascularization of any type results in reduced infarct volume in both thrombectomy and control groups. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01692379.
Authors: Mohammed A Almekhlafi; Fred Colbourne; Abdulaziz S Al Sultan; Mayank Goyal; Andrew M Demchuk Journal: J Cereb Blood Flow Metab Date: 2018-09-14 Impact factor: 6.200
Authors: Bijoy K Menon; Fahad S Al-Ajlan; Mohamed Najm; Josep Puig; Mar Castellanos; Dar Dowlatshahi; Ana Calleja; Sung-Il Sohn; Seong H Ahn; Alex Poppe; Robert Mikulik; Negar Asdaghi; Thalia S Field; Albert Jin; Talip Asil; Jean-Martin Boulanger; Eric E Smith; Shelagh B Coutts; Phil A Barber; Simerpreet Bal; Suresh Subramanian; Sachin Mishra; Anurag Trivedi; Sadanand Dey; Muneer Eesa; Tolulope Sajobi; Mayank Goyal; Michael D Hill; Andrew M Demchuk Journal: JAMA Date: 2018-09-11 Impact factor: 56.272
Authors: Silvia Reverté-Villarroya; Antoni Dávalos; Sílvia Font-Mayolas; Marta Berenguer-Poblet; Esther Sauras-Colón; Carlos López-Pablo; Estela Sanjuan-Menéndez; Lucía Muñoz-Narbona; Rosa Suñer-Soler Journal: Int J Environ Res Public Health Date: 2020-08-19 Impact factor: 3.390
Authors: Diana E Slawski; Hisham Salahuddin; Julie Shawver; Cynthia L Kenmuir; Gretchen E Tietjen; Andrea Korsnack; Syed F Zaidi; Mouhammad A Jumaa Journal: Interv Neurol Date: 2018-03-20