Johanna M Ospel1,2, Michael D Hill1,3, Andrew Demchuk1,3, Bijoy K Menon1,3, John Thornton4, Jeremy Rempel5, Mohammed A Almekhlafi1,3, Aravind Ganesh1, Manon Kappelhof1,6, Nishita Singh1, Petra Cimflova1, Nima Kashani1, Fouzi Bala1, Beom Joon Kim1, Ryan McTaggart7, Alexandre Poppe8, Raul G Nogueira9, Michael Tymianski10, Mayank Goyal11,12. 1. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. 2. Department of Radiology, University Hospital of Basel, Basel, Switzerland. 3. Department of Radiology, University of Calgary, Calgary, Canada. 4. Beaumont Hospital, Dublin, Ireland. 5. University of Alberta Hospital, Edmonton, Canada. 6. University Medical Center Amsterdam, Amsterdam, The Netherlands. 7. Warren Alpert School of Medicine, Brown University, Providence, USA. 8. Centre Hospitalier de L'Université de Montréal, Montreal, Canada. 9. Emory University School of Medicine, Grady Memorial Hospital, Atlanta, USA. 10. NoNO Inc, Toronto, Canada. 11. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. mgoyal@ucalgary.ca. 12. Department of Radiology, University of Calgary, Calgary, Canada. mgoyal@ucalgary.ca.
Abstract
BACKGROUND AND PURPOSE: Endovascular treatment (EVT) is a powerful treatment for large vessel occlusion (LVO) stroke if reperfusion can be achieved, while in cases with failed reperfusion, EVT may cause harm, as procedure-related complications may occur. We hypothesized that EVT with failed recanalization does not result in worse outcomes compared to best medical management and compared clinical outcomes of LVO stroke patients who underwent EVT with failed reperfusion to those who were treated with best medical management. METHODS: We included patients with failed reperfusion from the control (EVT-only) arm of the ESCAPE-NA1 trial and the EVT arm of the ESCAPE trial and patients of the ESCAPE control arm who were treated with best medical management. Failed reperfusion following EVT was defined as modified thrombolysis in cerebral infarction score 0-2a. Proportions of good outcome (modified Rankin scale 0-2) were compared between patients who did and did not undergo EVT, and adjusted effect size estimates for EVT on outcomes were obtained. RESULTS: We included 260 patients (110 failed EVT and 150 non-EVT patients). Proportions of good outcome were 38/110 (34.6%) with failed EVT vs.43/147 (29.3%) without EVT (adjusted odds ratio[aOR]: 1.48 [95%CI: 0.81-2.68]). Mortality and proportions of sICH in the failed EVT group vs. patients treated with best medical management were 26/110 (23.6%) vs. 28/147 (19.1%), aOR: 1.12 (95%CI: 0.56-2.24), and 7/110 (6.4%) vs. 4/150 (2.7%), aOR: 2.34 (95%CI: 0.00-22.97). CONCLUSION: Clinical outcomes of EVT patients with failed reperfusion did not differ significantly from patients treated with best medical management.
BACKGROUND AND PURPOSE: Endovascular treatment (EVT) is a powerful treatment for large vessel occlusion (LVO) stroke if reperfusion can be achieved, while in cases with failed reperfusion, EVT may cause harm, as procedure-related complications may occur. We hypothesized that EVT with failed recanalization does not result in worse outcomes compared to best medical management and compared clinical outcomes of LVO strokepatients who underwent EVT with failed reperfusion to those who were treated with best medical management. METHODS: We included patients with failed reperfusion from the control (EVT-only) arm of the ESCAPE-NA1 trial and the EVT arm of the ESCAPE trial and patients of the ESCAPE control arm who were treated with best medical management. Failed reperfusion following EVT was defined as modified thrombolysis in cerebral infarction score 0-2a. Proportions of good outcome (modified Rankin scale 0-2) were compared between patients who did and did not undergo EVT, and adjusted effect size estimates for EVT on outcomes were obtained. RESULTS: We included 260 patients (110 failed EVT and 150 non-EVTpatients). Proportions of good outcome were 38/110 (34.6%) with failed EVT vs.43/147 (29.3%) without EVT (adjusted odds ratio[aOR]: 1.48 [95%CI: 0.81-2.68]). Mortality and proportions of sICH in the failed EVT group vs. patients treated with best medical management were 26/110 (23.6%) vs. 28/147 (19.1%), aOR: 1.12 (95%CI: 0.56-2.24), and 7/110 (6.4%) vs. 4/150 (2.7%), aOR: 2.34 (95%CI: 0.00-22.97). CONCLUSION: Clinical outcomes of EVTpatients with failed reperfusion did not differ significantly from patients treated with best medical management.
Authors: Mayank Goyal; Bijoy K Menon; Wim H van Zwam; Diederik W J Dippel; Peter J Mitchell; Andrew M Demchuk; Antoni Dávalos; Charles B L M Majoie; Aad van der Lugt; Maria A de Miquel; Geoffrey A Donnan; Yvo B W E M Roos; Alain Bonafe; Reza Jahan; Hans-Christoph Diener; Lucie A van den Berg; Elad I Levy; Olvert A Berkhemer; Vitor M Pereira; Jeremy Rempel; Mònica Millán; Stephen M Davis; Daniel Roy; John Thornton; Luis San Román; Marc Ribó; Debbie Beumer; Bruce Stouch; Scott Brown; Bruce C V Campbell; Robert J van Oostenbrugge; Jeffrey L Saver; Michael D Hill; Tudor G Jovin Journal: Lancet Date: 2016-02-18 Impact factor: 79.321
Authors: Michael D Hill; Mayank Goyal; Bijoy K Menon; Raul G Nogueira; Ryan A McTaggart; Andrew M Demchuk; Alexandre Y Poppe; Brian H Buck; Thalia S Field; Dar Dowlatshahi; Brian A van Adel; Richard H Swartz; Ruchir A Shah; Eric Sauvageau; Charlotte Zerna; Johanna M Ospel; Manish Joshi; Mohammed A Almekhlafi; Karla J Ryckborst; Mark W Lowerison; Kathy Heard; David Garman; Diogo Haussen; Shawna M Cutting; Shelagh B Coutts; Daniel Roy; Jeremy L Rempel; Axel Cr Rohr; Daniela Iancu; Demetrios J Sahlas; Amy Y X Yu; Thomas G Devlin; Ricardo A Hanel; Volker Puetz; Frank L Silver; Bruce C V Campbell; René Chapot; Jeanne Teitelbaum; Jennifer L Mandzia; Timothy J Kleinig; David Turkel-Parrella; Donald Heck; Michael E Kelly; Aditya Bharatha; Oh Young Bang; Ashutosh Jadhav; Rishi Gupta; Donald F Frei; Jason W Tarpley; Cameron G McDougall; Staffan Holmin; Joung-Ho Rha; Ajit S Puri; Marie-Christine Camden; Götz Thomalla; Hana Choe; Stephen J Phillips; Joseph L Schindler; John Thornton; Simon Nagel; Ji Hoe Heo; Sung-Il Sohn; Marios-Nikos Psychogios; Ronald F Budzik; Sidney Starkman; Coleman O Martin; Paul A Burns; Seán Murphy; George A Lopez; Joey English; Michael Tymianski Journal: Lancet Date: 2020-02-20 Impact factor: 79.321
Authors: J Kaesmacher; J Gralla; P J Mosimann; F Zibold; M R Heldner; E Piechowiak; T Dobrocky; M Arnold; U Fischer; P Mordasini Journal: AJNR Am J Neuroradiol Date: 2018-08-30 Impact factor: 3.825
Authors: Osama O Zaidat; Albert J Yoo; Pooja Khatri; Thomas A Tomsick; Rüdiger von Kummer; Jeffrey L Saver; Michael P Marks; Shyam Prabhakaran; David F Kallmes; Brian-Fred M Fitzsimmons; J Mocco; Joanna M Wardlaw; Stanley L Barnwell; Tudor G Jovin; Italo Linfante; Adnan H Siddiqui; Michael J Alexander; Joshua A Hirsch; Max Wintermark; Gregory Albers; Henry H Woo; Donald V Heck; Michael Lev; Richard Aviv; Werner Hacke; Steven Warach; Joseph Broderick; Colin P Derdeyn; Anthony Furlan; Raul G Nogueira; Dileep R Yavagal; Mayank Goyal; Andrew M Demchuk; Martin Bendszus; David S Liebeskind Journal: Stroke Date: 2013-08-06 Impact factor: 7.914