Vessel Patency at 24 Hours and Its Relationship With Clinical Outcomes and Infarct Volume in REVASCAT Trial (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset)

BACKGROUND AND PURPOSE—Higher rates of target vessel patency at 24 hours were noted in the thrombectomy group compared with control group in recent randomized trials. As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as t...

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Veröffentlicht in:Stroke (1970) 2017-04, Vol.48 (4), p.983-989
Hauptverfasser: Millán, Mònica, Remollo, Sebastià, Quesada, Helena, Renú, Arturo, Tomasello, Alejandro, Minhas, Priyanka, Pérez de la Ossa, Natalia, Rubiera, Marta, Llull, Laura, Cardona, Pedro, Al-Ajlan, Fahad, Hernández, María, Assis, Zarina, Demchuk, Andrew M, Jovin, Tudor, Dávalos, Antoni
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container_issue 4
container_start_page 983
container_title Stroke (1970)
container_volume 48
creator Millán, Mònica
Remollo, Sebastià
Quesada, Helena
Renú, Arturo
Tomasello, Alejandro
Minhas, Priyanka
Pérez de la Ossa, Natalia
Rubiera, Marta
Llull, Laura
Cardona, Pedro
Al-Ajlan, Fahad
Hernández, María
Assis, Zarina
Demchuk, Andrew M
Jovin, Tudor
Dávalos, Antoni
description BACKGROUND AND PURPOSE—Higher rates of target vessel patency at 24 hours were noted in the thrombectomy group compared with control group in recent randomized trials. As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as they related to clinical outcome and 24-hour infarct volume in REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset). METHODS—Independent core laboratory adjudicated vessel status according to modified arterial occlusive lesion classification at 24 hours on computed tomographic/magnetic resonance (94.2%/5.8%) angiography and 24-hour infarct volume on computed tomography were studied (95/103 patients in the thrombectomy group versus 94/103 in the control group, respectively). Complete revascularization was defined as modified arterial occlusive lesion grade 3. Its effect on clinical outcome was analyzed by ordinal logistic regression. RESULTS—Complete revascularization was achieved in 70.5% of the solitaire group and in 22.3% of the control group (P
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As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as they related to clinical outcome and 24-hour infarct volume in REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset). METHODS—Independent core laboratory adjudicated vessel status according to modified arterial occlusive lesion classification at 24 hours on computed tomographic/magnetic resonance (94.2%/5.8%) angiography and 24-hour infarct volume on computed tomography were studied (95/103 patients in the thrombectomy group versus 94/103 in the control group, respectively). Complete revascularization was defined as modified arterial occlusive lesion grade 3. Its effect on clinical outcome was analyzed by ordinal logistic regression. RESULTS—Complete revascularization was achieved in 70.5% of the solitaire group and in 22.3% of the control group (P&lt;0.001). Significant differences in complete revascularization rates were found for terminus internal carotid artery, M1, and tandem occlusions (all P&lt;0.001) but not for M2 occlusions. In the thrombectomy group, 2 out of 63 patients (3.1%) with modified Thrombolysis in Cerebral Infarction 2b/3 after thrombectomy showed arterial reocclusion (modified arterial occlusive lesion grade 0/1) at 24 hours. Complete revascularization was associated with improved outcome in both thrombectomy (adjusted odds ratio, 4.5; 95% confidence interval, 1.9–10.9) and control groups (adjusted odds ratio, 2.7; 95% confidence interval, 1.0–6.7). Revascularization (modified arterial occlusive lesion grade 2/3) was associated with smaller infarct volumes in either treatment arm. CONCLUSIONS—Complete revascularization at 24 hours is a powerful predictor of favorable clinical outcome, whereas revascularization of any type results in reduced infarct volume in both thrombectomy and control groups. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01692379.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.116.015455</identifier><identifier>PMID: 28292867</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Aged ; Aged, 80 and over ; Arterial Occlusive Diseases - complications ; Arterial Occlusive Diseases - diagnostic imaging ; Arterial Occlusive Diseases - therapy ; Brain Infarction - diagnostic imaging ; Brain Infarction - etiology ; Cerebral Angiography ; Cerebral Arterial Diseases - complications ; Cerebral Arterial Diseases - diagnostic imaging ; Cerebral Arterial Diseases - therapy ; Cerebrovascular Circulation ; Computed Tomography Angiography ; Female ; Humans ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Thrombectomy - methods ; Time Factors</subject><ispartof>Stroke (1970), 2017-04, Vol.48 (4), p.983-989</ispartof><rights>2017 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4025-95c02f6102f9251d25fbd8a918c33899d3dcfc07e87d454325528ec148ffb97b3</citedby><cites>FETCH-LOGICAL-c4025-95c02f6102f9251d25fbd8a918c33899d3dcfc07e87d454325528ec148ffb97b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3673,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28292867$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Millán, Mònica</creatorcontrib><creatorcontrib>Remollo, Sebastià</creatorcontrib><creatorcontrib>Quesada, Helena</creatorcontrib><creatorcontrib>Renú, Arturo</creatorcontrib><creatorcontrib>Tomasello, Alejandro</creatorcontrib><creatorcontrib>Minhas, Priyanka</creatorcontrib><creatorcontrib>Pérez de la Ossa, Natalia</creatorcontrib><creatorcontrib>Rubiera, Marta</creatorcontrib><creatorcontrib>Llull, Laura</creatorcontrib><creatorcontrib>Cardona, Pedro</creatorcontrib><creatorcontrib>Al-Ajlan, Fahad</creatorcontrib><creatorcontrib>Hernández, María</creatorcontrib><creatorcontrib>Assis, Zarina</creatorcontrib><creatorcontrib>Demchuk, Andrew M</creatorcontrib><creatorcontrib>Jovin, Tudor</creatorcontrib><creatorcontrib>Dávalos, Antoni</creatorcontrib><creatorcontrib>REVASCAT Trial Investigators</creatorcontrib><title>Vessel Patency at 24 Hours and Its Relationship With Clinical Outcomes and Infarct Volume in REVASCAT Trial (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset)</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>BACKGROUND AND PURPOSE—Higher rates of target vessel patency at 24 hours were noted in the thrombectomy group compared with control group in recent randomized trials. As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as they related to clinical outcome and 24-hour infarct volume in REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset). METHODS—Independent core laboratory adjudicated vessel status according to modified arterial occlusive lesion classification at 24 hours on computed tomographic/magnetic resonance (94.2%/5.8%) angiography and 24-hour infarct volume on computed tomography were studied (95/103 patients in the thrombectomy group versus 94/103 in the control group, respectively). Complete revascularization was defined as modified arterial occlusive lesion grade 3. Its effect on clinical outcome was analyzed by ordinal logistic regression. RESULTS—Complete revascularization was achieved in 70.5% of the solitaire group and in 22.3% of the control group (P&lt;0.001). Significant differences in complete revascularization rates were found for terminus internal carotid artery, M1, and tandem occlusions (all P&lt;0.001) but not for M2 occlusions. In the thrombectomy group, 2 out of 63 patients (3.1%) with modified Thrombolysis in Cerebral Infarction 2b/3 after thrombectomy showed arterial reocclusion (modified arterial occlusive lesion grade 0/1) at 24 hours. Complete revascularization was associated with improved outcome in both thrombectomy (adjusted odds ratio, 4.5; 95% confidence interval, 1.9–10.9) and control groups (adjusted odds ratio, 2.7; 95% confidence interval, 1.0–6.7). Revascularization (modified arterial occlusive lesion grade 2/3) was associated with smaller infarct volumes in either treatment arm. CONCLUSIONS—Complete revascularization at 24 hours is a powerful predictor of favorable clinical outcome, whereas revascularization of any type results in reduced infarct volume in both thrombectomy and control groups. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01692379.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arterial Occlusive Diseases - complications</subject><subject>Arterial Occlusive Diseases - diagnostic imaging</subject><subject>Arterial Occlusive Diseases - therapy</subject><subject>Brain Infarction - diagnostic imaging</subject><subject>Brain Infarction - etiology</subject><subject>Cerebral Angiography</subject><subject>Cerebral Arterial Diseases - complications</subject><subject>Cerebral Arterial Diseases - diagnostic imaging</subject><subject>Cerebral Arterial Diseases - therapy</subject><subject>Cerebrovascular Circulation</subject><subject>Computed Tomography Angiography</subject><subject>Female</subject><subject>Humans</subject><subject>Magnetic Resonance Angiography</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Outcome Assessment (Health Care)</subject><subject>Thrombectomy - methods</subject><subject>Time Factors</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ktFv0zAQxgMCsTL4DxC6x_HQETtx6zyGrqPTijq1pTxGrnNZzJy42M6m7q_HacseebF1p---3-n0RdEnEl8SMiJfV-vl4naaz_K-vIwJSxl7HQ0Io-kwHVH-JhrEcZINaZplZ9F7537HcUwTzt5FZ5TTjPLRePDqdoPOoYY74bGVexAeaAoz01kHoi3hxjtYohZemdbVage_lK9holWrpNCw6Lw0DZ60bSWs9LAxumsQVAvL6SZfTfI1rK0K6otlkJlGPWN56pgquD8KJzstrHo-YI6IldHKC2URrpdwhY9KImzQus7BN3QefmB52GBdoxW7fU_zNQZbFL7B1vfWuew8wspb84Bw1SF4A3nr0SpjYaJsTz0Q58Le9_aHUyyk1J3r23cWXbBS7f1hp4CYqvvan84TAKt9s_OmgUXr0H_5EL2thHb48fSfRz-vp-vJbDhffL-Z5POhTGPKhhmTMa1GJDwZZaSkrNqWXGSEyyThWVYmpaxkPEY-LlOWJpQxylGSlFfVNhtvk_Po4ui7s-ZPF45RNMpJ1Fq0aDpXED4ec0ZjngVpepRKa5yzWBU7qxph9wWJiz5GxUuM-rI4xiiMfT4Rum2D5cvQv9wEAT8KnowO93QPuntCW9QotK__7_0XqGHa8w</recordid><startdate>201704</startdate><enddate>201704</enddate><creator>Millán, Mònica</creator><creator>Remollo, Sebastià</creator><creator>Quesada, Helena</creator><creator>Renú, Arturo</creator><creator>Tomasello, Alejandro</creator><creator>Minhas, Priyanka</creator><creator>Pérez de la Ossa, Natalia</creator><creator>Rubiera, Marta</creator><creator>Llull, Laura</creator><creator>Cardona, Pedro</creator><creator>Al-Ajlan, Fahad</creator><creator>Hernández, María</creator><creator>Assis, Zarina</creator><creator>Demchuk, Andrew M</creator><creator>Jovin, Tudor</creator><creator>Dávalos, Antoni</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201704</creationdate><title>Vessel Patency at 24 Hours and Its Relationship With Clinical Outcomes and Infarct Volume in REVASCAT Trial (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset)</title><author>Millán, Mònica ; Remollo, Sebastià ; Quesada, Helena ; Renú, Arturo ; Tomasello, Alejandro ; Minhas, Priyanka ; Pérez de la Ossa, Natalia ; Rubiera, Marta ; Llull, Laura ; Cardona, Pedro ; Al-Ajlan, Fahad ; Hernández, María ; Assis, Zarina ; Demchuk, Andrew M ; Jovin, Tudor ; Dávalos, Antoni</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4025-95c02f6102f9251d25fbd8a918c33899d3dcfc07e87d454325528ec148ffb97b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arterial Occlusive Diseases - complications</topic><topic>Arterial Occlusive Diseases - diagnostic imaging</topic><topic>Arterial Occlusive Diseases - therapy</topic><topic>Brain Infarction - diagnostic imaging</topic><topic>Brain Infarction - etiology</topic><topic>Cerebral Angiography</topic><topic>Cerebral Arterial Diseases - complications</topic><topic>Cerebral Arterial Diseases - diagnostic imaging</topic><topic>Cerebral Arterial Diseases - therapy</topic><topic>Cerebrovascular Circulation</topic><topic>Computed Tomography Angiography</topic><topic>Female</topic><topic>Humans</topic><topic>Magnetic Resonance Angiography</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Outcome Assessment (Health Care)</topic><topic>Thrombectomy - methods</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Millán, Mònica</creatorcontrib><creatorcontrib>Remollo, Sebastià</creatorcontrib><creatorcontrib>Quesada, Helena</creatorcontrib><creatorcontrib>Renú, Arturo</creatorcontrib><creatorcontrib>Tomasello, Alejandro</creatorcontrib><creatorcontrib>Minhas, Priyanka</creatorcontrib><creatorcontrib>Pérez de la Ossa, Natalia</creatorcontrib><creatorcontrib>Rubiera, Marta</creatorcontrib><creatorcontrib>Llull, Laura</creatorcontrib><creatorcontrib>Cardona, Pedro</creatorcontrib><creatorcontrib>Al-Ajlan, Fahad</creatorcontrib><creatorcontrib>Hernández, María</creatorcontrib><creatorcontrib>Assis, Zarina</creatorcontrib><creatorcontrib>Demchuk, Andrew M</creatorcontrib><creatorcontrib>Jovin, Tudor</creatorcontrib><creatorcontrib>Dávalos, Antoni</creatorcontrib><creatorcontrib>REVASCAT Trial Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Millán, Mònica</au><au>Remollo, Sebastià</au><au>Quesada, Helena</au><au>Renú, Arturo</au><au>Tomasello, Alejandro</au><au>Minhas, Priyanka</au><au>Pérez de la Ossa, Natalia</au><au>Rubiera, Marta</au><au>Llull, Laura</au><au>Cardona, Pedro</au><au>Al-Ajlan, Fahad</au><au>Hernández, María</au><au>Assis, Zarina</au><au>Demchuk, Andrew M</au><au>Jovin, Tudor</au><au>Dávalos, Antoni</au><aucorp>REVASCAT Trial Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vessel Patency at 24 Hours and Its Relationship With Clinical Outcomes and Infarct Volume in REVASCAT Trial (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset)</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2017-04</date><risdate>2017</risdate><volume>48</volume><issue>4</issue><spage>983</spage><epage>989</epage><pages>983-989</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><abstract>BACKGROUND AND PURPOSE—Higher rates of target vessel patency at 24 hours were noted in the thrombectomy group compared with control group in recent randomized trials. As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as they related to clinical outcome and 24-hour infarct volume in REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset). METHODS—Independent core laboratory adjudicated vessel status according to modified arterial occlusive lesion classification at 24 hours on computed tomographic/magnetic resonance (94.2%/5.8%) angiography and 24-hour infarct volume on computed tomography were studied (95/103 patients in the thrombectomy group versus 94/103 in the control group, respectively). Complete revascularization was defined as modified arterial occlusive lesion grade 3. Its effect on clinical outcome was analyzed by ordinal logistic regression. RESULTS—Complete revascularization was achieved in 70.5% of the solitaire group and in 22.3% of the control group (P&lt;0.001). Significant differences in complete revascularization rates were found for terminus internal carotid artery, M1, and tandem occlusions (all P&lt;0.001) but not for M2 occlusions. In the thrombectomy group, 2 out of 63 patients (3.1%) with modified Thrombolysis in Cerebral Infarction 2b/3 after thrombectomy showed arterial reocclusion (modified arterial occlusive lesion grade 0/1) at 24 hours. Complete revascularization was associated with improved outcome in both thrombectomy (adjusted odds ratio, 4.5; 95% confidence interval, 1.9–10.9) and control groups (adjusted odds ratio, 2.7; 95% confidence interval, 1.0–6.7). Revascularization (modified arterial occlusive lesion grade 2/3) was associated with smaller infarct volumes in either treatment arm. CONCLUSIONS—Complete revascularization at 24 hours is a powerful predictor of favorable clinical outcome, whereas revascularization of any type results in reduced infarct volume in both thrombectomy and control groups. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01692379.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>28292867</pmid><doi>10.1161/STROKEAHA.116.015455</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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source MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete; Alma/SFX Local Collection
subjects Aged
Aged, 80 and over
Arterial Occlusive Diseases - complications
Arterial Occlusive Diseases - diagnostic imaging
Arterial Occlusive Diseases - therapy
Brain Infarction - diagnostic imaging
Brain Infarction - etiology
Cerebral Angiography
Cerebral Arterial Diseases - complications
Cerebral Arterial Diseases - diagnostic imaging
Cerebral Arterial Diseases - therapy
Cerebrovascular Circulation
Computed Tomography Angiography
Female
Humans
Magnetic Resonance Angiography
Male
Middle Aged
Outcome Assessment (Health Care)
Thrombectomy - methods
Time Factors
title Vessel Patency at 24 Hours and Its Relationship With Clinical Outcomes and Infarct Volume in REVASCAT Trial (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset)
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