Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/132052
Citations | ||
Scopus | Web of Science® | Altmetric |
---|---|---|
?
|
?
|
Type: | Journal article |
Title: | Exploring the relationship between ischemic core volume and clinical outcomes after thrombectomy or thrombolysis |
Author: | Chen, C. Parsons, M.W. Levi, C.R. Spratt, N.J. Miteff, F. Lin, L. Cheng, X. Lou, M. Kleinig, T. Butcher, K. Dong, Q. Bivard, A. |
Citation: | Neurology, 2019; 93(3):E283-E292 |
Publisher: | AAN Publications |
Issue Date: | 2019 |
ISSN: | 0028-3878 1526-632X |
Statement of Responsibility: | Chushuang Chen, Mark W. Parsons, Christopher R. Levi, Neil J. Spratt, Ferdinand Miteff, Longting Lin ... et al. |
Abstract: | OBJECTIVE:To assess whether complete reperfusion after IV thrombolysis (IVT-R) would result in similar clinical outcomes compared to complete reperfusion after endovascular thrombectomy (EVT-R) in patients with a large vessel occlusion (LVO). METHODS:EVT-R patients were matched by age, clinical severity, occlusion location, and baseline perfusion lesion volume to IVT-R patients from the International Stroke Perfusion Imaging Registry (INSPIRE). Only patients with complete reperfusion on follow-up imaging were included. The excellent clinical outcome rates at day 90 on the modified Rankin Scale (mRS) were compared between EVT-R vs IVT-R patients within quintiles of increasing baseline ischemic core and penumbral volumes. RESULTS:From INSPIRE, there were 141 EVT-R patients and 141 matched controls (IVT-R) who met the eligibility criteria. In patients with a baseline core <30 mL, EVT-R resulted in a lower odds of achieving an excellent outcome at day 90 compared to IVT-R (day 90 mRS 0-1 odds ratio 0.01, p < 0.001). The group with a baseline core <30 mL contained mostly patients with distal M1 or M2 occlusions, and good collaterals (p = 0.01). In patients with a baseline ischemic core volume >30 mL (internal carotid artery and mostly proximal M1 occlusions), EVT-R increased the odds of patients achieving an excellent clinical outcome (day 90 mRS 0-1 odds ratio 1.61, p < 0.001) and there was increased symptomatic intracranial hemorrhage in the IVT-R group with core >30 mL (20% vs 3% in EVT-R, p = 0.008). CONCLUSION:From this observational cohort, LVO patients with larger baseline ischemic cores and proximal LVO, with poorer collaterals, clearly benefited from EVT-R compared to IVT-R alone. However, for distal LVO patients, with smaller ischemic cores and better collaterals, EVT-R was associated with a lower odds of favorable outcome compared to IVT-R alone. |
Keywords: | Humans Infarction, Middle Cerebral Artery Intracranial Hemorrhages Prognosis Thrombolytic Therapy Thrombectomy Cohort Studies Cerebrovascular Circulation Collateral Circulation Aged Aged, 80 and over Middle Aged Female Male Stroke Endovascular Procedures |
Rights: | © 2019 American Academy of Neurology |
DOI: | 10.1212/WNL.0000000000007768 |
Published version: | http://dx.doi.org/10.1212/wnl.0000000000007768 |
Appears in Collections: | Medicine publications |
Files in This Item:
There are no files associated with this item.
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.