Prediction of recanalization in acute stroke patients receiving intravenous and endovascular revascularization therapy.

Details

Serval ID
serval:BIB_2F152D7ED9F5
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Prediction of recanalization in acute stroke patients receiving intravenous and endovascular revascularization therapy.
Journal
International Journal of Stroke
Author(s)
Zhu G., Michel P., Jovin T., Patrie J.T., Xin W., Eskandari A., Zhang W., Wintermark M.
ISSN
1747-4949 (Electronic)
ISSN-L
1747-4930
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
10
Number
1
Pages
28-36
Language
english
Notes
Publication types: Journal Article Publication Status: ppublish
Abstract
BACKGROUND AND PURPOSE: The study aims to assess the recanalization rate in acute ischemic stroke patients who received no revascularization therapy, intravenous thrombolysis, and endovascular treatment, respectively, and to identify best clinical and imaging predictors of recanalization in each treatment group.
METHODS: Clinical and imaging data were collected in 103 patients with acute ischemic stroke caused by anterior circulation arterial occlusion. We recorded demographics and vascular risk factors. We reviewed the noncontrast head computed tomographies to assess for hyperdense middle cerebral artery and its computed tomography density. We reviewed the computed tomography angiograms and the raw images to determine the site and degree of arterial occlusion, collateral score, clot burden score, and the density of the clot. Recanalization status was assessed on recanalization imaging using Thrombolysis in Myocardial Ischemia. Multivariate logistic regressions were utilized to determine the best predictors of outcome in each treatment group.
RESULTS: Among the 103 study patients, 43 (42%) received intravenous thrombolysis, 34 (33%) received endovascular thrombolysis, and 26 (25%) did not receive any revascularization therapy. In the patients with intravenous thrombolysis or no revascularization therapy, recanalization of the vessel was more likely with intravenous thrombolysis (P = 0·046) and when M1/A1 was occluded (P = 0·001). In this subgroup of patients, clot burden score, cervical degree of stenosis (North American Symptomatic Carotid Endarterectomy Trial), and hyperlipidemia status added information to the aforementioned likelihood of recanalization at the patient level (P < 0·001). In patients with endovascular thrombolysis, recanalization of the vessel was more likely in the case of a higher computed tomography angiogram clot density (P = 0·012), and in this subgroup of patients gender added information to the likelihood of recanalization at the patient level (P = 0·044).
CONCLUSION: The overall likelihood of recanalization was the highest in the endovascular group, and higher for intravenous thrombolysis compared with no revascularization therapy. However, our statistical models of recanalization for each individual patient indicate significant variability between treatment options, suggesting the need to include this prediction in the personalized treatment selection.
Pubmed
Web of science
Create date
09/01/2015 20:05
Last modification date
20/08/2019 13:13
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