Improving prediction of recanalization in acute large-vessel occlusive stroke.

Détails

ID Serval
serval:BIB_3B85B1F061E8
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Improving prediction of recanalization in acute large-vessel occlusive stroke.
Périodique
Journal of Thrombosis and Haemostasis
Auteur(s)
Vanacker P., Lambrou D., Eskandari A., Maeder P., Meuli R., Ntaios G., Michel P.
ISSN
1538-7836 (Electronic)
ISSN-L
1538-7836
Statut éditorial
Publié
Date de publication
2014
Peer-reviewed
Oui
Volume
12
Numéro
6
Pages
814-821
Langue
anglais
Notes
Publication types: Journal ArticlePublication Status: ppublish
Résumé
BACKGROUND: Recanalization in acute ischemic stroke with large-vessel occlusion is a potent indicator of good clinical outcome.
OBJECTIVE: To identify easily available clinical and radiologic variables predicting recanalization at various occlusion sites.
METHODS: All consecutive, acute stroke patients from the Acute STroke Registry and Analysis of Lausanne (2003-2011) who had a large-vessel occlusion on computed tomographic angiography (CTA) (< 12 h) were included. Recanalization status was assessed at 24 h (range: 12-48 h) with CTA, magnetic resonance angiography, or ultrasonography. Complete and partial recanalization (corresponding to the modified Treatment in Cerebral Ischemia scale 2-3) were grouped together. Patients were categorized according to occlusion site and treatment modality.
RESULTS: Among 439 patients, 51% (224) showed complete or partial recanalization. In multivariate analysis, recanalization of any occlusion site was most strongly associated with endovascular treatment, including bridging therapy (odds ratio [OR] 7.1, 95% confidence interval [CI] 2.2-23.2), and less so with intravenous thrombolysis (OR 1.6, 95% CI 1.0-2.6) and recanalization treatments performed beyond guidelines (OR 2.6, 95% CI 1.2-5.7). Clot location (large vs. intermediate) and tandem pathology (the combination of intracranial occlusion and symptomatic extracranial stenosis) were other variables discriminating between recanalizers and non-recanalizers. For patients with intracranial occlusions, the variables significantly associated with recanalization after 24 h were: baseline National Institutes of Health Stroke Scale (NIHSS) (OR 1.04, 95% CI 1.02-1.1), Alberta Stroke Program Early CT Score (ASPECTS) on initial computed tomography (OR 1.2, 95% CI 1.1-1.3), and an altered level of consciousness (OR 0.2, 95% CI 0.1-0.5).
CONCLUSIONS: Acute endovascular treatment is the single most important factor promoting recanalization in acute ischemic stroke. The presence of extracranial vessel stenosis or occlusion decreases recanalization rates. In patients with intracranial occlusions, higher NIHSS score and ASPECTS and normal vigilance facilitate recanalization. Clinical use of these predictors could influence recanalization strategies in individual patients.
Pubmed
Web of science
Création de la notice
19/03/2014 11:55
Dernière modification de la notice
20/08/2019 13:31
Données d'usage