Sung-Ju Hsueh1, Chih-Hao Chen2, Shin-Joe Yeh2, Yen-Heng Lin3, Li-Kai Tsai2, Chung-Wei Lee3, Sung-Chun Tang4, Jiann-Shing Jeng2. 1. Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. 2. Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. 3. Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan. 4. Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: sctang@ntuh.gov.tw.
Abstract
BACKGROUND/ PURPOSE: Endovascular thrombectomy (EVT) is effective in treating acute ischemic stroke associated with large vessel occlusion. Early recurrence of ischemic stroke (ERIS) after EVT, however, is a devastating event and could worsen the condition of patient. Current study aimed to investigate the prevalence and risk factors of ERIS after EVT. METHODS: The medical records of all patients receiving EVT at a single medical center were reviewed and analyzed. ERIS was defined as presentation of newly developed neurological deficits in previously recanalized vascular territory or another vascular territory that was not initially involved within 30 days of the index stroke. RESULTS: From January 2015 to September 2018, a total of 200 patients (71.6 ± 12.3 years, male 49%) had received EVT and 17 patients (8.5%) developed ERIS. Presence of valvular heart disease was the only clinical factor associated with ERIS (OR: 4.26, 95% CI: 1.16-17.7). Patients with ERIS had significantly worse modified Rankin scale at 3 months (common OR: 3.11, 95% CI: 1.18-8.73) and were independently associated with mortality (OR: 7.73, 95% CI: 2.00-30.6). Ten of 17 patients with ERIS had received repeated EVT and all achieved good recanalization without procedure-related complications or symptomatic intracerebral hemorrhage. CONCLUSION: ERIS in patients receiving EVT was not rare, especially in those with valvular heart disease, and was associated with worse outcome. Nevertheless, they could be safely treated by repeated EVT.
BACKGROUND/ PURPOSE: Endovascular thrombectomy (EVT) is effective in treating acute ischemic stroke associated with large vessel occlusion. Early recurrence of ischemic stroke (ERIS) after EVT, however, is a devastating event and could worsen the condition of patient. Current study aimed to investigate the prevalence and risk factors of ERIS after EVT. METHODS: The medical records of all patients receiving EVT at a single medical center were reviewed and analyzed. ERIS was defined as presentation of newly developed neurological deficits in previously recanalized vascular territory or another vascular territory that was not initially involved within 30 days of the index stroke. RESULTS: From January 2015 to September 2018, a total of 200 patients (71.6 ± 12.3 years, male 49%) had received EVT and 17 patients (8.5%) developed ERIS. Presence of valvular heart disease was the only clinical factor associated with ERIS (OR: 4.26, 95% CI: 1.16-17.7). Patients with ERIS had significantly worse modified Rankin scale at 3 months (common OR: 3.11, 95% CI: 1.18-8.73) and were independently associated with mortality (OR: 7.73, 95% CI: 2.00-30.6). Ten of 17 patients with ERIS had received repeated EVT and all achieved good recanalization without procedure-related complications or symptomatic intracerebral hemorrhage. CONCLUSION:ERIS in patients receiving EVT was not rare, especially in those with valvular heart disease, and was associated with worse outcome. Nevertheless, they could be safely treated by repeated EVT.
Authors: Alessandro De Stefano; Francesco Dispenza; Gautham Kulamarva; Giuseppina Lamarca; Antonio Faita; Antonio Merico; Giuseppe Sardanelli; Salvatore Gabellone; Antonio Antonaci Journal: Eur Arch Otorhinolaryngol Date: 2020-10-17 Impact factor: 2.503