Incomplete Large Vessel Occlusions in Mechanical Thrombectomy: An Independent Predictor of Favorable Outcome in Ischemic Stroke
| Autor: | Thomas Liebig, Seunghwa You, Henning Stetefeld, Gereon R. Fink, Jan Borggrefe, Alev Kalkan, Volker Maus, Anastasios Mpotsaris, Christian Dohmen, Utako Birgit Barnikol, Christoph Kabbasch |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Time Factors Computed Tomography Angiography 030204 cardiovascular system & hematology Logistic regression Brain Ischemia Disability Evaluation 0302 clinical medicine Risk Factors Modified Rankin Scale Germany Odds Ratio Clinical endpoint Favorable outcome Acute ischemic stroke Thrombectomy Aged 80 and over Mortality rate Middle Aged Stroke Treatment Outcome medicine.anatomical_structure Neurology Cerebrovascular Circulation Cardiology Female Cerebral Arterial Diseases Cardiology and Cardiovascular Medicine medicine.medical_specialty Perfusion Imaging 03 medical and health sciences Internal medicine medicine Humans Vascular Patency Aged Retrospective Studies Groin business.industry Angiography Digital Subtraction Cerebral Arteries Cerebral Angiography Mechanical thrombectomy Logistic Models Multivariate Analysis Physical therapy Neurology (clinical) Intracranial Thrombosis business Magnetic Resonance Angiography 030217 neurology & neurosurgery |
| Zdroj: | Cerebrovascular Diseases. 44:113-121 |
| ISSN: | 1421-9786 1015-9770 |
| DOI: | 10.1159/000477499 |
| Popis: | Background and Purpose: Cerebral large vessel occlusion (LVO) in acute ischemic stroke (AIS) may be complete (CLVO) or incomplete (ILVO). The influence of ILVO on clinical outcome after mechanical thrombectomy (MT) remains unclear. We investigated primarily the clinical outcome in patients with AIS due to ILVO or CLVO. Methods: Five hundred three consecutive AIS patients with LVO treated with stent-retriever or direct aspiration-based MT between 2010 and 2016 were analyzed. The primary endpoint was favorable clinical outcome (modified Rankin Scale ≤2) at 90 days; secondary endpoints were periprocedural parameters. Results: Forty-nine patients (11.3%) with a median National Institutes of Health Stroke Scale (NIHSS) of 11 presented with ILVO and the remainder presented with CLVO and median NIHSS of 15 (p < 0.001). The median groin puncture-to-reperfusion time was 30 vs. 67 min, respectively (p < 0.001). Successful reperfusion was reached in 47 out of 49 ILVO (95.9%) vs. 298 out of 381 CLVO (78.2%; p < 0.005) with less retrieval maneuvers (1.7 ± 2.2 vs. 3.0 ± 2.5; p < 0.001). The favorable outcome at 90 days was 81% in patients with ILVO vs. 29.1% in CLVO (p < 0.001); respective all-cause mortality rates were 6.4 vs. 28.5% (p < 0.001). Periprocedural complications (6.9%) occurred exclusively in CLVO patients (p < 0.05). ILVO was associated with favorable clinical outcome independent of age and NIHSS in multivariate logistic regression both in the anterior (OR 3.6; 95% CI 1.8-6.9; p < 0.001) and posterior circulation (OR 3.5; 95% CI 1.8-6.9; p < 0.001). Conclusions: AIS due to ILVO is frequent and is associated with a nearly threefold higher chance of favorable clinical outcome at 90 days, independent of age and initial NIHSS compared to CLVO. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|