Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
| Autor: | Hyungjong Park, Sung Ik Lee, Tae Jin Song, Hye Sun Lee, Byung Moon Kim, Jong-Won Chung, Yo Han Jung, Hyo Suk Nam, Hye Yeon Choi, Kwon-Duk Seo, Sang Won Han, Jeong-Ho Hong, Oh Young Bang, Seo Hyun Kim, Ji Hoe Heo, Gyu Sik Kim, Kyung-Yul Lee, Dong Hoon Shin, Joong Hyun Park, Jin Kyo Choi, Han-Jin Cho, Young Dae Kim, JoonNyung Heo, Woo-Keun Seo, Jang Hyun Baek, Joonsang Yoo, Sung Il Sohn, Seong Hwan Ahn, Dong Joon Kim, Jinkwon Kim |
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| Rok vydání: | 2021 |
| Předmět: |
thrombolysis
medicine.medical_specialty medicine.medical_treatment ischemia Internal medicine Occlusion Diseases of the circulatory (Cardiovascular) system Medicine Derivation Stroke thrombosis business.industry Area under the curve Thrombolysis medicine.disease stroke Thrombosis Confidence interval reperfusion RC666-701 Cardiology Original Article Neurology (clinical) Bolus (digestion) Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Stroke, Vol 23, Iss 2, Pp 244-252 (2021) Journal of Stroke |
| ISSN: | 2287-6405 2287-6391 |
| Popis: | Background and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion.Methods Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization.Results Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032).Conclusions The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion. |
| Databáze: | OpenAIRE |
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