Multimodal reperfusion therapy for acute ischemic stroke : Factors predicting vessel recanalization
Endovascular therapies using mechanical and pharmacological modalities for large vessel occlusions in acute stroke are rapidly evolving. Our aim was to determine whether one modality is associated with higher recanalization rates. We retrospectively reviewed 168 consecutive patients treated with int...
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| Veröffentlicht in: | Stroke (1970) 2006-04, Vol.37 (4), p.986-990 |
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| container_title | Stroke (1970) |
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| creator | GUPTA, Rishi VORA, Nirav A HOROWITZ, Michael B TAYAL, Ashis H HAMMER, Maxim D UCHINO, Ken LEVY, Elad I WECHSLER, Lawrence R JOVIN, Tudor G |
| description | Endovascular therapies using mechanical and pharmacological modalities for large vessel occlusions in acute stroke are rapidly evolving. Our aim was to determine whether one modality is associated with higher recanalization rates.
We retrospectively reviewed 168 consecutive patients treated with intra-arterial (IA) therapy for acute ischemic stroke between May 1999 and November 15, 2005. Demographic, clinical, radiographic, angiographic, and procedural notes were reviewed. Recanalization was defined as achieving thrombolysis in myocardial infarction 2 or 3 flow after intervention. A logistic regression model was constructed to determine independent predictors of successful recanalization.
A total of 168 patients were reviewed with a mean age of 64+/-13 years and mean National Institutes of Health Stroke Scale score of 17+/-4. Recanalization was achieved in 106 (63%) patients. Independent predictors of recanalization include: the combination of IA thrombolytics and glycoprotein IIb/IIIa inhibitors (odds ratio [OR], 2.9 [95% CI, 1.04 to 6.7]; P |
| doi_str_mv | 10.1161/01.STR.0000209303.02474.27 |
| format | Article |
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We retrospectively reviewed 168 consecutive patients treated with intra-arterial (IA) therapy for acute ischemic stroke between May 1999 and November 15, 2005. Demographic, clinical, radiographic, angiographic, and procedural notes were reviewed. Recanalization was defined as achieving thrombolysis in myocardial infarction 2 or 3 flow after intervention. A logistic regression model was constructed to determine independent predictors of successful recanalization.
A total of 168 patients were reviewed with a mean age of 64+/-13 years and mean National Institutes of Health Stroke Scale score of 17+/-4. Recanalization was achieved in 106 (63%) patients. Independent predictors of recanalization include: the combination of IA thrombolytics and glycoprotein IIb/IIIa inhibitors (odds ratio [OR], 2.9 [95% CI, 1.04 to 6.7]; P<0.048), intracranial stent placement with angioplasty (OR, 4.8 [95% CI, 1.8 to 10.0]; P<0.001), or extracranial stent placement with angioplasty (OR, 4.2 [95% CI, 1.4 to 9.8]; P<0.014). Lesions at the terminus of the internal carotid artery were recalcitrant to revascularization (OR, 0.34 [95% CI, 0.16 to 0.73]; P value 0.006).
Intracranial or extracranial stenting or combination therapy with IA thrombolytics and glycoprotein IIb/IIIa inhibitors in the setting of multimodal therapy is associated with successful recanalization in patients treated with multimodal endovascular reperfusion therapy for acute ischemic stroke.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.0000209303.02474.27</identifier><identifier>PMID: 16527997</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Blood. Blood coagulation. Reticuloendothelial system ; Brain Ischemia - complications ; Cohort Studies ; Fibrinolytic Agents - administration & dosage ; Fibrinolytic Agents - therapeutic use ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Humans ; Injections, Intra-Arterial ; Medical sciences ; Middle Aged ; Nervous system (semeiology, syndromes) ; Neurology ; Pharmacology. Drug treatments ; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors ; Prognosis ; Reperfusion - methods ; Reperfusion - standards ; Retrospective Studies ; Severity of Illness Index ; Stents ; Stroke - etiology ; Stroke - physiopathology ; Stroke - therapy ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2006-04, Vol.37 (4), p.986-990</ispartof><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c325t-76f201ef8a76e79503dd162a20b47fba5d5c21b34dc26931ef6190cb4ec7c6d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,3688,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17645992$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16527997$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>GUPTA, Rishi</creatorcontrib><creatorcontrib>VORA, Nirav A</creatorcontrib><creatorcontrib>HOROWITZ, Michael B</creatorcontrib><creatorcontrib>TAYAL, Ashis H</creatorcontrib><creatorcontrib>HAMMER, Maxim D</creatorcontrib><creatorcontrib>UCHINO, Ken</creatorcontrib><creatorcontrib>LEVY, Elad I</creatorcontrib><creatorcontrib>WECHSLER, Lawrence R</creatorcontrib><creatorcontrib>JOVIN, Tudor G</creatorcontrib><title>Multimodal reperfusion therapy for acute ischemic stroke : Factors predicting vessel recanalization</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Endovascular therapies using mechanical and pharmacological modalities for large vessel occlusions in acute stroke are rapidly evolving. Our aim was to determine whether one modality is associated with higher recanalization rates.
We retrospectively reviewed 168 consecutive patients treated with intra-arterial (IA) therapy for acute ischemic stroke between May 1999 and November 15, 2005. Demographic, clinical, radiographic, angiographic, and procedural notes were reviewed. Recanalization was defined as achieving thrombolysis in myocardial infarction 2 or 3 flow after intervention. A logistic regression model was constructed to determine independent predictors of successful recanalization.
A total of 168 patients were reviewed with a mean age of 64+/-13 years and mean National Institutes of Health Stroke Scale score of 17+/-4. Recanalization was achieved in 106 (63%) patients. Independent predictors of recanalization include: the combination of IA thrombolytics and glycoprotein IIb/IIIa inhibitors (odds ratio [OR], 2.9 [95% CI, 1.04 to 6.7]; P<0.048), intracranial stent placement with angioplasty (OR, 4.8 [95% CI, 1.8 to 10.0]; P<0.001), or extracranial stent placement with angioplasty (OR, 4.2 [95% CI, 1.4 to 9.8]; P<0.014). Lesions at the terminus of the internal carotid artery were recalcitrant to revascularization (OR, 0.34 [95% CI, 0.16 to 0.73]; P value 0.006).
Intracranial or extracranial stenting or combination therapy with IA thrombolytics and glycoprotein IIb/IIIa inhibitors in the setting of multimodal therapy is associated with successful recanalization in patients treated with multimodal endovascular reperfusion therapy for acute ischemic stroke.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Brain Ischemia - complications</subject><subject>Cohort Studies</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Humans</subject><subject>Injections, Intra-Arterial</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Pharmacology. Drug treatments</subject><subject>Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors</subject><subject>Prognosis</subject><subject>Reperfusion - methods</subject><subject>Reperfusion - standards</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Stents</subject><subject>Stroke - etiology</subject><subject>Stroke - physiopathology</subject><subject>Stroke - therapy</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1PGzEQhq2KqqSBv4AsJLjt1l9rx9xQBG2lVJVK7pbXOwuG_cL2Vgq_HgciZS5zed53Rg9Cl5SUlEr6g9DyYfuvJHkY0ZzwkjChRMnUF7SgFROFkGx1ghaEcF0wofUp-h7j857nq-obOqWyYkprtUDuz9wl34-N7XCACUI7Rz8OOD1BsNMOt2PA1s0JsI_uCXrvcExhfAF8g--tS2OIeArQeJf88Ij_Q4ywb3J2sJ1_symXnaGvre0inB_2Em3v77brX8Xm78_f69tN4TirUqFkywiFdmWVBKUrwpuGSmYZqYVqa1s1lWO05qJxTGqeSUk1cbUAp5xs-BJdf9ZOYXydISbT55-h6-wA4xyNVCuaDbAM3nyCLowxBmjNFHxvw85QYvaGDaEmGzZHw-bDsGEqhy8OV-a6h-YYPSjNwNUBsNHZrg12cD4eOSVFpTXj70uCho0</recordid><startdate>20060401</startdate><enddate>20060401</enddate><creator>GUPTA, Rishi</creator><creator>VORA, Nirav A</creator><creator>HOROWITZ, Michael B</creator><creator>TAYAL, Ashis H</creator><creator>HAMMER, Maxim D</creator><creator>UCHINO, Ken</creator><creator>LEVY, Elad I</creator><creator>WECHSLER, Lawrence R</creator><creator>JOVIN, Tudor G</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><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>20060401</creationdate><title>Multimodal reperfusion therapy for acute ischemic stroke : Factors predicting vessel recanalization</title><author>GUPTA, Rishi ; VORA, Nirav A ; HOROWITZ, Michael B ; TAYAL, Ashis H ; HAMMER, Maxim D ; UCHINO, Ken ; LEVY, Elad I ; WECHSLER, Lawrence R ; JOVIN, Tudor G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c325t-76f201ef8a76e79503dd162a20b47fba5d5c21b34dc26931ef6190cb4ec7c6d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Brain Ischemia - complications</topic><topic>Cohort Studies</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Humans</topic><topic>Injections, Intra-Arterial</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Pharmacology. Drug treatments</topic><topic>Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors</topic><topic>Prognosis</topic><topic>Reperfusion - methods</topic><topic>Reperfusion - standards</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Stents</topic><topic>Stroke - etiology</topic><topic>Stroke - physiopathology</topic><topic>Stroke - therapy</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>GUPTA, Rishi</creatorcontrib><creatorcontrib>VORA, Nirav A</creatorcontrib><creatorcontrib>HOROWITZ, Michael B</creatorcontrib><creatorcontrib>TAYAL, Ashis H</creatorcontrib><creatorcontrib>HAMMER, Maxim D</creatorcontrib><creatorcontrib>UCHINO, Ken</creatorcontrib><creatorcontrib>LEVY, Elad I</creatorcontrib><creatorcontrib>WECHSLER, Lawrence R</creatorcontrib><creatorcontrib>JOVIN, Tudor G</creatorcontrib><collection>Pascal-Francis</collection><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>GUPTA, Rishi</au><au>VORA, Nirav A</au><au>HOROWITZ, Michael B</au><au>TAYAL, Ashis H</au><au>HAMMER, Maxim D</au><au>UCHINO, Ken</au><au>LEVY, Elad I</au><au>WECHSLER, Lawrence R</au><au>JOVIN, Tudor G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multimodal reperfusion therapy for acute ischemic stroke : Factors predicting vessel recanalization</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2006-04-01</date><risdate>2006</risdate><volume>37</volume><issue>4</issue><spage>986</spage><epage>990</epage><pages>986-990</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>Endovascular therapies using mechanical and pharmacological modalities for large vessel occlusions in acute stroke are rapidly evolving. Our aim was to determine whether one modality is associated with higher recanalization rates.
We retrospectively reviewed 168 consecutive patients treated with intra-arterial (IA) therapy for acute ischemic stroke between May 1999 and November 15, 2005. Demographic, clinical, radiographic, angiographic, and procedural notes were reviewed. Recanalization was defined as achieving thrombolysis in myocardial infarction 2 or 3 flow after intervention. A logistic regression model was constructed to determine independent predictors of successful recanalization.
A total of 168 patients were reviewed with a mean age of 64+/-13 years and mean National Institutes of Health Stroke Scale score of 17+/-4. Recanalization was achieved in 106 (63%) patients. Independent predictors of recanalization include: the combination of IA thrombolytics and glycoprotein IIb/IIIa inhibitors (odds ratio [OR], 2.9 [95% CI, 1.04 to 6.7]; P<0.048), intracranial stent placement with angioplasty (OR, 4.8 [95% CI, 1.8 to 10.0]; P<0.001), or extracranial stent placement with angioplasty (OR, 4.2 [95% CI, 1.4 to 9.8]; P<0.014). Lesions at the terminus of the internal carotid artery were recalcitrant to revascularization (OR, 0.34 [95% CI, 0.16 to 0.73]; P value 0.006).
Intracranial or extracranial stenting or combination therapy with IA thrombolytics and glycoprotein IIb/IIIa inhibitors in the setting of multimodal therapy is associated with successful recanalization in patients treated with multimodal endovascular reperfusion therapy for acute ischemic stroke.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>16527997</pmid><doi>10.1161/01.STR.0000209303.02474.27</doi><tpages>5</tpages></addata></record> |
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| ispartof | Stroke (1970), 2006-04, Vol.37 (4), p.986-990 |
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| source | MEDLINE; American Heart Association; Journals@Ovid Complete; Free E-Journal (出版社公開部分のみ）; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Biological and medical sciences Blood. Blood coagulation. Reticuloendothelial system Brain Ischemia - complications Cohort Studies Fibrinolytic Agents - administration & dosage Fibrinolytic Agents - therapeutic use Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Injections, Intra-Arterial Medical sciences Middle Aged Nervous system (semeiology, syndromes) Neurology Pharmacology. Drug treatments Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors Prognosis Reperfusion - methods Reperfusion - standards Retrospective Studies Severity of Illness Index Stents Stroke - etiology Stroke - physiopathology Stroke - therapy Vascular diseases and vascular malformations of the nervous system |
| title | Multimodal reperfusion therapy for acute ischemic stroke : Factors predicting vessel recanalization |
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