Intravenous Thrombolysis and Passes of Thrombectomy as Predictors for Endovascular Revascularization in Ischemic Stroke.

Autor: Angermaier A; Department of Neurology, University Medicine Greifswald, Greifswald, Germany. Electronic address: anselm.angermaier@uni-greifswald.de., Michel P; Stroke Center, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Lausanne, Switzerland., Khaw AV; Department of Neurology, University Medicine Greifswald, Greifswald, Germany; Department of Clinical Neurosciences, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada., Kirsch M; Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany., Kessler C; Department of Neurology, University Medicine Greifswald, Greifswald, Germany., Langner S; Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2016 Oct; Vol. 25 (10), pp. 2488-95. Date of Electronic Publication: 2016 Aug 02.
DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.024
Abstrakt: Background: Patient selection for endovascular revascularization treatment (ERT) in acute ischemic stroke depends on the expected benefit-risk ratio. As rapid revascularization is a major determinant of good functional outcome, we aimed to identify its predictors after ERT.
Methods: Consecutive stroke patients from a single stroke center with distal internal carotid artery-, proximal middle cerebral artery- or T-occlusions treated with ERT were retrospectively selected. We assessed admission noncontrast computed tomography and computed tomography angiography for thrombus location, thrombus load (clot burden score), and collateral status. Clinical data were extracted from medical charts. Univariate and multivariate regression analyses were performed to identify predictors of revascularization (thrombolysis in cerebral infarction ≥2b) after ERT.
Results: A total of 63 patients were identified (median age, 73 years; interquartile range: 62-77; 40 females). Sixteen patients (25.4%) underwent intravenous thrombolysis (ivT) before ERT. Twenty-two patients (34.9%) had additional intra-arterial application of recombinant tissue plasminogen activator. The overall recanalization rate was 66.7%, and 9.5% had symptomatic intracranial bleeding. In-hospital mortality was 15%, and 30% reached good functional outcome at discharge. In the univariate analysis, preceding ivT and the number of passes for thrombectomy (dichotomized ≤2 versus >2) were associated with recanalization. There was a trend for number of thrombectomy passes (as continuous variable) and multimodal ERT. In the multivariate regression analysis, ivT prior to ERT and passes of thrombectomy were identified as independent predictors for recanalization.
Conclusion: ivT and lower passes of thrombectomy are associated with recanalization after ERT for ischemic stroke with proximal vessel occlusions.
(Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: