Improving the Prediction of Spontaneous and Post-thrombolytic Recanalization in Ischemic Stroke Patients.

Détails

ID Serval
serval:BIB_9D9134CD5A26
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Improving the Prediction of Spontaneous and Post-thrombolytic Recanalization in Ischemic Stroke Patients.
Périodique
Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
Auteur(s)
Vanacker P., Lambrou D., Eskandari A., Ntaios G., Cras P., Maeder P., Meuli R., Michel P.
ISSN
1532-8511 (Electronic)
ISSN-L
1052-3057
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
24
Numéro
8
Pages
1781-1786
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
BACKGROUND: Endovascular treatment for acute ischemic stroke patients was recently shown to improve recanalization rates and clinical outcome in a well-defined study population. Intravenous thrombolysis (IVT) alone is insufficiently effective to recanalize in certain patients or of little value in others. Accordingly, we aimed at identifying predictors of recanalization in patients treated with or without IVT.
METHODS: In the observational Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry, we selected those stroke patients (1) with an arterial occlusion on computed tomography angiography (CTA) imaging, (2) who had an arterial patency assessment at 24 hours (CTA/magnetic resonance angiography/transcranial Doppler), and (3) who were treated with IVT or had no revascularization treatment. Based on 2 separate logistic regression analyses, predictors of spontaneous and post-thrombolytic recanalization were generated.
RESULTS: Partial or complete recanalization was achieved in 121 of 210 (58%) thrombolyzed patients. Recanalization was associated with atrial fibrillation (odds ratio , 1.6; 95% confidence interval, 1.2-3.0) and absence of early ischemic changes on CT (1.1, 1.1-1.2) and inversely correlated with the presence of a significant extracranial (EC) stenosis or occlusion (.6, .3-.9). In nonthrombolyzed patients, partial or complete recanalization was significantly less frequent (37%, P < .01). The recanalization was independently associated with a history of hypercholesterolemia (2.6, 1.2-5.6) and the proximal site of the intracranial occlusion (2.5, 1.2-5.4), and inversely correlated with a decreased level of consciousness (.3, .1-.8), and EC (.3, .1-.6) and basilar artery pathology (.1, .0-.6).
CONCLUSIONS: Various clinical findings, cardiovascular risk factors, and arterial pathology on acute CTA-based imaging are moderately associated with spontaneous and post-thrombolytic arterial recanalization at 24 hours. If confirmed in other studies, this information may influence patient selection toward the most appropriate revascularization strategy.
Mots-clé
Aged, Aged, 80 and over, Brain Ischemia/complications, Endovascular Procedures, Female, Humans, Magnetic Resonance Angiography, Male, Retrospective Studies, Stroke/etiology, Stroke/therapy, Thrombolytic Therapy/adverse effects, Thrombolytic Therapy/methods, Tomography Scanners, X-Ray Computed, Treatment Outcome, Ultrasonography, Doppler, Transcranial
Pubmed
Web of science
Création de la notice
28/08/2015 17:36
Dernière modification de la notice
20/08/2019 15:03
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