Faculty Collaboration Database

Intra-arterial thrombolysis or stent placement during endovascular treatment for acute ischemic stroke leads to the highest recanalization rate: results of a multicenter retrospective study. Neurosurgery 2011 Jun;68(6):1618-22; discussion 1622-3

Date

02/22/2011

Pubmed ID

21336221

DOI

10.1227/NEU.0b013e31820f156c

Scopus ID

2-s2.0-79955880226 (requires institutional sign-in at Scopus site)   29 Citations

Abstract

BACKGROUND: Reperfusion therapy for acute ischemic stroke (AIS) is rapidly evolving, with the development of multiple endovascular modalities that can be used alone or in combination.

OBJECTIVE: To determine which pharmacologic or mechanical modality may be associated with increased rates of recanalization.

METHODS: A cohort of 1122 patients with AIS involving the anterior circulation treated at 13 stroke centers underwent intra-arterial (IA) therapy within 8 hours of symptom onset. Demographic information, admission National Institutes of Health Stroke Scale (NIHSS), mechanical and pharmacologic treatments used, recanalization grade, and hemorrhagic complications were recorded.

RESULTS: The mean age was 67 ± 16 years and the median NIHSS was 17. The sites of arterial occlusion before treatment were M1 middle cerebral artery (MCA) in 561 (50%) patients, carotid terminus in 214 (19%) patients, M2 MCA in 171 (15%) patients, tandem occlusions in 141 (13%) patients, and isolated extracranial internal carotid artery occlusion in 35 (3%) patients. Therapeutic interventions included multimodal therapy in 584 (52%) patients, pharmacologic therapy only in 264 (24%) patients, and mechanical therapy only in 274 (24%) patients. Patients treated with multimodal therapy had a significantly higher Thrombolysis in Myocardial Infarction 2 or 3 recanalization rate (435 patients [74%]) compared with pharmacologic therapy only (160 patients, [61%]) or mechanical only therapy (173 patients [63%]), P<.001. In binary logistic regression modeling, independent predictors of Thrombolysis in Myocardial Infarction 2 or 3 recanalization were use of IA thrombolytic OR 1.58 (1.21-2.08), P<.001 and stent deployment 1.91 (1.23-2.96), P<.001.

CONCLUSION: Multimodal therapy has significantly higher recanalization rates compared with pharmacologic or mechanical therapy. Among the individual treatment modalities, stent deployment or IA thrombolytics increase the chance of recanalization.

Author List

Gupta R, Tayal AH, Levy EI, Cheng-Ching E, Rai A, Liebeskind DS, Yoo AJ, Hsu DP, Rymer MM, Zaidat OO, Lin R, Natarajan SK, Nogueira RG, Nanda A, Tian M, Hao Q, Abou-Chebl A, Kalia JS, Nguyen TN, Chen M, Jovin TG

MESH terms used to index this publication - Major topics in bold

Aged
Combined Modality Therapy
Endovascular Procedures
Female
Fibrinolytic Agents
Humans
Male
Middle Aged
Retrospective Studies
Stents
Stroke
Thrombolytic Therapy
Tissue Plasminogen Activator
Treatment Outcome