Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke
IMPORTANCE: Recanalization of intracranial thrombus is associated with improved clinical outcome in patients with acute ischemic stroke. The association of intravenous alteplase treatment and thrombus characteristics with recanalization over time is important for stroke triage and future trial desig...
Gespeichert in:
| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2018-09, Vol.320 (10), p.1017-1026 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1026 |
|---|---|
| container_issue | 10 |
| container_start_page | 1017 |
| container_title | JAMA : the journal of the American Medical Association |
| container_volume | 320 |
| creator | Menon, Bijoy K Al-Ajlan, Fahad S Najm, Mohamed Puig, Josep Castellanos, Mar Dowlatshahi, Dar Calleja, Ana Sohn, Sung-Il Ahn, Seong H Poppe, Alex Mikulik, Robert Asdaghi, Negar Field, Thalia S Jin, Albert Asil, Talip Boulanger, Jean-Martin Smith, Eric E Coutts, Shelagh B Barber, Phil A Bal, Simerpreet Subramanian, Suresh Mishra, Sachin Trivedi, Anurag Dey, Sadanand Eesa, Muneer Sajobi, Tolulope Goyal, Mayank Hill, Michael D Demchuk, Andrew M |
| description | IMPORTANCE: Recanalization of intracranial thrombus is associated with improved clinical outcome in patients with acute ischemic stroke. The association of intravenous alteplase treatment and thrombus characteristics with recanalization over time is important for stroke triage and future trial design. OBJECTIVE: To examine recanalization over time across a range of intracranial thrombus occlusion sites and clinical and imaging characteristics in patients with ischemic stroke treated with intravenous alteplase or not treated with alteplase. DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective cohort study of 575 patients from 12 centers (in Canada, Spain, South Korea, the Czech Republic, and Turkey) with acute ischemic stroke and intracranial arterial occlusion demonstrated on computed tomographic angiography (CTA). EXPOSURES: Demographics, clinical characteristics, time from alteplase to recanalization, and intracranial thrombus characteristics (location and permeability) defined on CTA. MAIN OUTCOMES AND MEASURES: Recanalization on repeat CTA or on first angiographic acquisition of affected intracranial circulation obtained within 6 hours of baseline CTA, defined using the revised arterial occlusion scale (rAOL) (scores from 0 [primary occlusive lesion remains the same] to 3 [complete revascularization of primary occlusion]). RESULTS: Among 575 patients (median age, 72 years [IQR, 63-80]; 51.5% men; median time from patient last known well to baseline CTA of 114 minutes [IQR, 74-180]), 275 patients (47.8%) received intravenous alteplase only, 195 (33.9%) received intravenous alteplase plus endovascular thrombectomy, 48 (8.3%) received endovascular thrombectomy alone, and 57 (9.9%) received conservative treatment. Median time from baseline CTA to recanalization assessment was 158 minutes (IQR, 79-268); median time from intravenous alteplase start to recanalization assessment was 132.5 minutes (IQR, 62-238). Successful recanalization occurred at an unadjusted rate of 27.3% (157/575) overall, including in 30.4% (143/470) of patients who received intravenous alteplase and 13.3% (14/105) who did not (difference, 17.1% [95% CI, 10.2%-25.8%]). Among patients receiving alteplase, the following factors were associated with recanalization: time from treatment start to recanalization assessment (OR, 1.28 for every 30-minute increase in time [95% CI, 1.18-1.38]), more distal thrombus location, eg, distal M1 middle cerebral artery (39/84 [46.4%]) vs internal car |
| doi_str_mv | 10.1001/jama.2018.12498 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6143104</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>2702146</ama_id><sourcerecordid>2103675148</sourcerecordid><originalsourceid>FETCH-LOGICAL-a440t-2c2639df80e9d770d920af77e8254ee8fdc612c9f1b27afeca9ee3027dc3723c3</originalsourceid><addsrcrecordid>eNpdkc1uEzEURi0EoqGwRmKBLLFh0Un9N7FngxRF0Eaq1AoKLC3H48k4eOxie5DgVXhZPCSNCt54cc89vr4fAC8xmmOE8PlODWpOEBZzTFgjHoEZrqmoaN2Ix2CGUCMqzgQ7Ac9S2qFyMOVPwQlFBAlW1zPwe5lS0FZlGzwMHVw5661W7gyuB7W1fnsGlW_hbR_DsBkTXPUqKp1NtClbneBXm3v40WjllbO_jpovNtmNM3Dtc8Gj8lY5eK21G9NEWA9vCmt8PhiWesyFTro3g9XwU47hm3kOnnTKJfPicJ-Czx_e364uq6vri_VqeVUpxlCuiCYL2rSdQKZpOUdtQ5DqODeC1MwY0bV6gYluOrwhXHVl1saYsgHeasoJ1fQUvNt778bNYFptpqGdvIt2UPGnDMrKfyve9nIbfsgFZhQjVgRvD4IYvo8mZTnYpI1zypswJkkwogteYyYK-uY_dBfGWJY3UZgVSjST8HxP6RhSiqY7DoORnIKXU_ByCl7-Db50vH74hyN_n3QBXu2BqfG-Sjgi5VH6B21_taE</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2114675894</pqid></control><display><type>article</type><title>Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Menon, Bijoy K ; Al-Ajlan, Fahad S ; Najm, Mohamed ; Puig, Josep ; Castellanos, Mar ; Dowlatshahi, Dar ; Calleja, Ana ; Sohn, Sung-Il ; Ahn, Seong H ; Poppe, Alex ; Mikulik, Robert ; Asdaghi, Negar ; Field, Thalia S ; Jin, Albert ; Asil, Talip ; Boulanger, Jean-Martin ; Smith, Eric E ; Coutts, Shelagh B ; Barber, Phil A ; Bal, Simerpreet ; Subramanian, Suresh ; Mishra, Sachin ; Trivedi, Anurag ; Dey, Sadanand ; Eesa, Muneer ; Sajobi, Tolulope ; Goyal, Mayank ; Hill, Michael D ; Demchuk, Andrew M</creator><creatorcontrib>Menon, Bijoy K ; Al-Ajlan, Fahad S ; Najm, Mohamed ; Puig, Josep ; Castellanos, Mar ; Dowlatshahi, Dar ; Calleja, Ana ; Sohn, Sung-Il ; Ahn, Seong H ; Poppe, Alex ; Mikulik, Robert ; Asdaghi, Negar ; Field, Thalia S ; Jin, Albert ; Asil, Talip ; Boulanger, Jean-Martin ; Smith, Eric E ; Coutts, Shelagh B ; Barber, Phil A ; Bal, Simerpreet ; Subramanian, Suresh ; Mishra, Sachin ; Trivedi, Anurag ; Dey, Sadanand ; Eesa, Muneer ; Sajobi, Tolulope ; Goyal, Mayank ; Hill, Michael D ; Demchuk, Andrew M ; INTERRSeCT Study Investigators ; for the INTERRSeCT Study Investigators</creatorcontrib><description>IMPORTANCE: Recanalization of intracranial thrombus is associated with improved clinical outcome in patients with acute ischemic stroke. The association of intravenous alteplase treatment and thrombus characteristics with recanalization over time is important for stroke triage and future trial design. OBJECTIVE: To examine recanalization over time across a range of intracranial thrombus occlusion sites and clinical and imaging characteristics in patients with ischemic stroke treated with intravenous alteplase or not treated with alteplase. DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective cohort study of 575 patients from 12 centers (in Canada, Spain, South Korea, the Czech Republic, and Turkey) with acute ischemic stroke and intracranial arterial occlusion demonstrated on computed tomographic angiography (CTA). EXPOSURES: Demographics, clinical characteristics, time from alteplase to recanalization, and intracranial thrombus characteristics (location and permeability) defined on CTA. MAIN OUTCOMES AND MEASURES: Recanalization on repeat CTA or on first angiographic acquisition of affected intracranial circulation obtained within 6 hours of baseline CTA, defined using the revised arterial occlusion scale (rAOL) (scores from 0 [primary occlusive lesion remains the same] to 3 [complete revascularization of primary occlusion]). RESULTS: Among 575 patients (median age, 72 years [IQR, 63-80]; 51.5% men; median time from patient last known well to baseline CTA of 114 minutes [IQR, 74-180]), 275 patients (47.8%) received intravenous alteplase only, 195 (33.9%) received intravenous alteplase plus endovascular thrombectomy, 48 (8.3%) received endovascular thrombectomy alone, and 57 (9.9%) received conservative treatment. Median time from baseline CTA to recanalization assessment was 158 minutes (IQR, 79-268); median time from intravenous alteplase start to recanalization assessment was 132.5 minutes (IQR, 62-238). Successful recanalization occurred at an unadjusted rate of 27.3% (157/575) overall, including in 30.4% (143/470) of patients who received intravenous alteplase and 13.3% (14/105) who did not (difference, 17.1% [95% CI, 10.2%-25.8%]). Among patients receiving alteplase, the following factors were associated with recanalization: time from treatment start to recanalization assessment (OR, 1.28 for every 30-minute increase in time [95% CI, 1.18-1.38]), more distal thrombus location, eg, distal M1 middle cerebral artery (39/84 [46.4%]) vs internal carotid artery (10/92 [10.9%]) (OR, 5.61 [95% CI, 2.38-13.26]), and higher residual flow (thrombus permeability) grade, eg, hairline streak (30/45 [66.7%]) vs none (91/377 [24.1%]) (OR, 7.03 [95% CI, 3.32-14.87]). CONCLUSIONS AND RELEVANCE: In patients with acute ischemic stroke, more distal thrombus location, greater thrombus permeability, and longer time to recanalization assessment were associated with recanalization of arterial occlusion after administration of intravenous alteplase; among patients who did not receive alteplase, rates of arterial recanalization were low. These findings may help inform treatment and triage decisions in patients with acute ischemic stroke.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.2018.12498</identifier><identifier>PMID: 30208455</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Administration, Intravenous ; Aged ; Aged, 80 and over ; Angiography ; Blood clots ; Brain Ischemia - drug therapy ; Brain Ischemia - surgery ; Cardiovascular system ; Carotid artery ; Cerebral blood flow ; Clinical outcomes ; Combined Modality Therapy ; Computed tomography ; Computed Tomography Angiography ; Demographics ; Demography ; Female ; Fibrinolytic Agents - therapeutic use ; Humans ; Intravenous administration ; Ischemia ; Male ; Medical imaging ; Middle Aged ; Occlusion ; Original Investigation ; Patients ; Permeability ; Prospective Studies ; Stroke ; Stroke - diagnostic imaging ; Stroke - drug therapy ; Stroke - surgery ; Thrombectomy ; Thrombosis ; Tissue Plasminogen Activator - therapeutic use ; Treatment Outcome</subject><ispartof>JAMA : the journal of the American Medical Association, 2018-09, Vol.320 (10), p.1017-1026</ispartof><rights>Copyright American Medical Association Sep 11, 2018</rights><rights>Copyright 2018 American Medical Association. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a440t-2c2639df80e9d770d920af77e8254ee8fdc612c9f1b27afeca9ee3027dc3723c3</citedby><cites>FETCH-LOGICAL-a440t-2c2639df80e9d770d920af77e8254ee8fdc612c9f1b27afeca9ee3027dc3723c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.2018.12498$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.12498$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,776,780,881,3327,27901,27902,76232,76235</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30208455$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Menon, Bijoy K</creatorcontrib><creatorcontrib>Al-Ajlan, Fahad S</creatorcontrib><creatorcontrib>Najm, Mohamed</creatorcontrib><creatorcontrib>Puig, Josep</creatorcontrib><creatorcontrib>Castellanos, Mar</creatorcontrib><creatorcontrib>Dowlatshahi, Dar</creatorcontrib><creatorcontrib>Calleja, Ana</creatorcontrib><creatorcontrib>Sohn, Sung-Il</creatorcontrib><creatorcontrib>Ahn, Seong H</creatorcontrib><creatorcontrib>Poppe, Alex</creatorcontrib><creatorcontrib>Mikulik, Robert</creatorcontrib><creatorcontrib>Asdaghi, Negar</creatorcontrib><creatorcontrib>Field, Thalia S</creatorcontrib><creatorcontrib>Jin, Albert</creatorcontrib><creatorcontrib>Asil, Talip</creatorcontrib><creatorcontrib>Boulanger, Jean-Martin</creatorcontrib><creatorcontrib>Smith, Eric E</creatorcontrib><creatorcontrib>Coutts, Shelagh B</creatorcontrib><creatorcontrib>Barber, Phil A</creatorcontrib><creatorcontrib>Bal, Simerpreet</creatorcontrib><creatorcontrib>Subramanian, Suresh</creatorcontrib><creatorcontrib>Mishra, Sachin</creatorcontrib><creatorcontrib>Trivedi, Anurag</creatorcontrib><creatorcontrib>Dey, Sadanand</creatorcontrib><creatorcontrib>Eesa, Muneer</creatorcontrib><creatorcontrib>Sajobi, Tolulope</creatorcontrib><creatorcontrib>Goyal, Mayank</creatorcontrib><creatorcontrib>Hill, Michael D</creatorcontrib><creatorcontrib>Demchuk, Andrew M</creatorcontrib><creatorcontrib>INTERRSeCT Study Investigators</creatorcontrib><creatorcontrib>for the INTERRSeCT Study Investigators</creatorcontrib><title>Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>IMPORTANCE: Recanalization of intracranial thrombus is associated with improved clinical outcome in patients with acute ischemic stroke. The association of intravenous alteplase treatment and thrombus characteristics with recanalization over time is important for stroke triage and future trial design. OBJECTIVE: To examine recanalization over time across a range of intracranial thrombus occlusion sites and clinical and imaging characteristics in patients with ischemic stroke treated with intravenous alteplase or not treated with alteplase. DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective cohort study of 575 patients from 12 centers (in Canada, Spain, South Korea, the Czech Republic, and Turkey) with acute ischemic stroke and intracranial arterial occlusion demonstrated on computed tomographic angiography (CTA). EXPOSURES: Demographics, clinical characteristics, time from alteplase to recanalization, and intracranial thrombus characteristics (location and permeability) defined on CTA. MAIN OUTCOMES AND MEASURES: Recanalization on repeat CTA or on first angiographic acquisition of affected intracranial circulation obtained within 6 hours of baseline CTA, defined using the revised arterial occlusion scale (rAOL) (scores from 0 [primary occlusive lesion remains the same] to 3 [complete revascularization of primary occlusion]). RESULTS: Among 575 patients (median age, 72 years [IQR, 63-80]; 51.5% men; median time from patient last known well to baseline CTA of 114 minutes [IQR, 74-180]), 275 patients (47.8%) received intravenous alteplase only, 195 (33.9%) received intravenous alteplase plus endovascular thrombectomy, 48 (8.3%) received endovascular thrombectomy alone, and 57 (9.9%) received conservative treatment. Median time from baseline CTA to recanalization assessment was 158 minutes (IQR, 79-268); median time from intravenous alteplase start to recanalization assessment was 132.5 minutes (IQR, 62-238). Successful recanalization occurred at an unadjusted rate of 27.3% (157/575) overall, including in 30.4% (143/470) of patients who received intravenous alteplase and 13.3% (14/105) who did not (difference, 17.1% [95% CI, 10.2%-25.8%]). Among patients receiving alteplase, the following factors were associated with recanalization: time from treatment start to recanalization assessment (OR, 1.28 for every 30-minute increase in time [95% CI, 1.18-1.38]), more distal thrombus location, eg, distal M1 middle cerebral artery (39/84 [46.4%]) vs internal carotid artery (10/92 [10.9%]) (OR, 5.61 [95% CI, 2.38-13.26]), and higher residual flow (thrombus permeability) grade, eg, hairline streak (30/45 [66.7%]) vs none (91/377 [24.1%]) (OR, 7.03 [95% CI, 3.32-14.87]). CONCLUSIONS AND RELEVANCE: In patients with acute ischemic stroke, more distal thrombus location, greater thrombus permeability, and longer time to recanalization assessment were associated with recanalization of arterial occlusion after administration of intravenous alteplase; among patients who did not receive alteplase, rates of arterial recanalization were low. These findings may help inform treatment and triage decisions in patients with acute ischemic stroke.</description><subject>Administration, Intravenous</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiography</subject><subject>Blood clots</subject><subject>Brain Ischemia - drug therapy</subject><subject>Brain Ischemia - surgery</subject><subject>Cardiovascular system</subject><subject>Carotid artery</subject><subject>Cerebral blood flow</subject><subject>Clinical outcomes</subject><subject>Combined Modality Therapy</subject><subject>Computed tomography</subject><subject>Computed Tomography Angiography</subject><subject>Demographics</subject><subject>Demography</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Humans</subject><subject>Intravenous administration</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Occlusion</subject><subject>Original Investigation</subject><subject>Patients</subject><subject>Permeability</subject><subject>Prospective Studies</subject><subject>Stroke</subject><subject>Stroke - diagnostic imaging</subject><subject>Stroke - drug therapy</subject><subject>Stroke - surgery</subject><subject>Thrombectomy</subject><subject>Thrombosis</subject><subject>Tissue Plasminogen Activator - therapeutic use</subject><subject>Treatment Outcome</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc1uEzEURi0EoqGwRmKBLLFh0Un9N7FngxRF0Eaq1AoKLC3H48k4eOxie5DgVXhZPCSNCt54cc89vr4fAC8xmmOE8PlODWpOEBZzTFgjHoEZrqmoaN2Ix2CGUCMqzgQ7Ac9S2qFyMOVPwQlFBAlW1zPwe5lS0FZlGzwMHVw5661W7gyuB7W1fnsGlW_hbR_DsBkTXPUqKp1NtClbneBXm3v40WjllbO_jpovNtmNM3Dtc8Gj8lY5eK21G9NEWA9vCmt8PhiWesyFTro3g9XwU47hm3kOnnTKJfPicJ-Czx_e364uq6vri_VqeVUpxlCuiCYL2rSdQKZpOUdtQ5DqODeC1MwY0bV6gYluOrwhXHVl1saYsgHeasoJ1fQUvNt778bNYFptpqGdvIt2UPGnDMrKfyve9nIbfsgFZhQjVgRvD4IYvo8mZTnYpI1zypswJkkwogteYyYK-uY_dBfGWJY3UZgVSjST8HxP6RhSiqY7DoORnIKXU_ByCl7-Db50vH74hyN_n3QBXu2BqfG-Sjgi5VH6B21_taE</recordid><startdate>20180911</startdate><enddate>20180911</enddate><creator>Menon, Bijoy K</creator><creator>Al-Ajlan, Fahad S</creator><creator>Najm, Mohamed</creator><creator>Puig, Josep</creator><creator>Castellanos, Mar</creator><creator>Dowlatshahi, Dar</creator><creator>Calleja, Ana</creator><creator>Sohn, Sung-Il</creator><creator>Ahn, Seong H</creator><creator>Poppe, Alex</creator><creator>Mikulik, Robert</creator><creator>Asdaghi, Negar</creator><creator>Field, Thalia S</creator><creator>Jin, Albert</creator><creator>Asil, Talip</creator><creator>Boulanger, Jean-Martin</creator><creator>Smith, Eric E</creator><creator>Coutts, Shelagh B</creator><creator>Barber, Phil A</creator><creator>Bal, Simerpreet</creator><creator>Subramanian, Suresh</creator><creator>Mishra, Sachin</creator><creator>Trivedi, Anurag</creator><creator>Dey, Sadanand</creator><creator>Eesa, Muneer</creator><creator>Sajobi, Tolulope</creator><creator>Goyal, Mayank</creator><creator>Hill, Michael D</creator><creator>Demchuk, Andrew M</creator><general>American Medical Association</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>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180911</creationdate><title>Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke</title><author>Menon, Bijoy K ; Al-Ajlan, Fahad S ; Najm, Mohamed ; Puig, Josep ; Castellanos, Mar ; Dowlatshahi, Dar ; Calleja, Ana ; Sohn, Sung-Il ; Ahn, Seong H ; Poppe, Alex ; Mikulik, Robert ; Asdaghi, Negar ; Field, Thalia S ; Jin, Albert ; Asil, Talip ; Boulanger, Jean-Martin ; Smith, Eric E ; Coutts, Shelagh B ; Barber, Phil A ; Bal, Simerpreet ; Subramanian, Suresh ; Mishra, Sachin ; Trivedi, Anurag ; Dey, Sadanand ; Eesa, Muneer ; Sajobi, Tolulope ; Goyal, Mayank ; Hill, Michael D ; Demchuk, Andrew M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a440t-2c2639df80e9d770d920af77e8254ee8fdc612c9f1b27afeca9ee3027dc3723c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Administration, Intravenous</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiography</topic><topic>Blood clots</topic><topic>Brain Ischemia - drug therapy</topic><topic>Brain Ischemia - surgery</topic><topic>Cardiovascular system</topic><topic>Carotid artery</topic><topic>Cerebral blood flow</topic><topic>Clinical outcomes</topic><topic>Combined Modality Therapy</topic><topic>Computed tomography</topic><topic>Computed Tomography Angiography</topic><topic>Demographics</topic><topic>Demography</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Humans</topic><topic>Intravenous administration</topic><topic>Ischemia</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Middle Aged</topic><topic>Occlusion</topic><topic>Original Investigation</topic><topic>Patients</topic><topic>Permeability</topic><topic>Prospective Studies</topic><topic>Stroke</topic><topic>Stroke - diagnostic imaging</topic><topic>Stroke - drug therapy</topic><topic>Stroke - surgery</topic><topic>Thrombectomy</topic><topic>Thrombosis</topic><topic>Tissue Plasminogen Activator - therapeutic use</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Menon, Bijoy K</creatorcontrib><creatorcontrib>Al-Ajlan, Fahad S</creatorcontrib><creatorcontrib>Najm, Mohamed</creatorcontrib><creatorcontrib>Puig, Josep</creatorcontrib><creatorcontrib>Castellanos, Mar</creatorcontrib><creatorcontrib>Dowlatshahi, Dar</creatorcontrib><creatorcontrib>Calleja, Ana</creatorcontrib><creatorcontrib>Sohn, Sung-Il</creatorcontrib><creatorcontrib>Ahn, Seong H</creatorcontrib><creatorcontrib>Poppe, Alex</creatorcontrib><creatorcontrib>Mikulik, Robert</creatorcontrib><creatorcontrib>Asdaghi, Negar</creatorcontrib><creatorcontrib>Field, Thalia S</creatorcontrib><creatorcontrib>Jin, Albert</creatorcontrib><creatorcontrib>Asil, Talip</creatorcontrib><creatorcontrib>Boulanger, Jean-Martin</creatorcontrib><creatorcontrib>Smith, Eric E</creatorcontrib><creatorcontrib>Coutts, Shelagh B</creatorcontrib><creatorcontrib>Barber, Phil A</creatorcontrib><creatorcontrib>Bal, Simerpreet</creatorcontrib><creatorcontrib>Subramanian, Suresh</creatorcontrib><creatorcontrib>Mishra, Sachin</creatorcontrib><creatorcontrib>Trivedi, Anurag</creatorcontrib><creatorcontrib>Dey, Sadanand</creatorcontrib><creatorcontrib>Eesa, Muneer</creatorcontrib><creatorcontrib>Sajobi, Tolulope</creatorcontrib><creatorcontrib>Goyal, Mayank</creatorcontrib><creatorcontrib>Hill, Michael D</creatorcontrib><creatorcontrib>Demchuk, Andrew M</creatorcontrib><creatorcontrib>INTERRSeCT Study Investigators</creatorcontrib><creatorcontrib>for the INTERRSeCT Study 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>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Menon, Bijoy K</au><au>Al-Ajlan, Fahad S</au><au>Najm, Mohamed</au><au>Puig, Josep</au><au>Castellanos, Mar</au><au>Dowlatshahi, Dar</au><au>Calleja, Ana</au><au>Sohn, Sung-Il</au><au>Ahn, Seong H</au><au>Poppe, Alex</au><au>Mikulik, Robert</au><au>Asdaghi, Negar</au><au>Field, Thalia S</au><au>Jin, Albert</au><au>Asil, Talip</au><au>Boulanger, Jean-Martin</au><au>Smith, Eric E</au><au>Coutts, Shelagh B</au><au>Barber, Phil A</au><au>Bal, Simerpreet</au><au>Subramanian, Suresh</au><au>Mishra, Sachin</au><au>Trivedi, Anurag</au><au>Dey, Sadanand</au><au>Eesa, Muneer</au><au>Sajobi, Tolulope</au><au>Goyal, Mayank</au><au>Hill, Michael D</au><au>Demchuk, Andrew M</au><aucorp>INTERRSeCT Study Investigators</aucorp><aucorp>for the INTERRSeCT Study Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2018-09-11</date><risdate>2018</risdate><volume>320</volume><issue>10</issue><spage>1017</spage><epage>1026</epage><pages>1017-1026</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><abstract>IMPORTANCE: Recanalization of intracranial thrombus is associated with improved clinical outcome in patients with acute ischemic stroke. The association of intravenous alteplase treatment and thrombus characteristics with recanalization over time is important for stroke triage and future trial design. OBJECTIVE: To examine recanalization over time across a range of intracranial thrombus occlusion sites and clinical and imaging characteristics in patients with ischemic stroke treated with intravenous alteplase or not treated with alteplase. DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective cohort study of 575 patients from 12 centers (in Canada, Spain, South Korea, the Czech Republic, and Turkey) with acute ischemic stroke and intracranial arterial occlusion demonstrated on computed tomographic angiography (CTA). EXPOSURES: Demographics, clinical characteristics, time from alteplase to recanalization, and intracranial thrombus characteristics (location and permeability) defined on CTA. MAIN OUTCOMES AND MEASURES: Recanalization on repeat CTA or on first angiographic acquisition of affected intracranial circulation obtained within 6 hours of baseline CTA, defined using the revised arterial occlusion scale (rAOL) (scores from 0 [primary occlusive lesion remains the same] to 3 [complete revascularization of primary occlusion]). RESULTS: Among 575 patients (median age, 72 years [IQR, 63-80]; 51.5% men; median time from patient last known well to baseline CTA of 114 minutes [IQR, 74-180]), 275 patients (47.8%) received intravenous alteplase only, 195 (33.9%) received intravenous alteplase plus endovascular thrombectomy, 48 (8.3%) received endovascular thrombectomy alone, and 57 (9.9%) received conservative treatment. Median time from baseline CTA to recanalization assessment was 158 minutes (IQR, 79-268); median time from intravenous alteplase start to recanalization assessment was 132.5 minutes (IQR, 62-238). Successful recanalization occurred at an unadjusted rate of 27.3% (157/575) overall, including in 30.4% (143/470) of patients who received intravenous alteplase and 13.3% (14/105) who did not (difference, 17.1% [95% CI, 10.2%-25.8%]). Among patients receiving alteplase, the following factors were associated with recanalization: time from treatment start to recanalization assessment (OR, 1.28 for every 30-minute increase in time [95% CI, 1.18-1.38]), more distal thrombus location, eg, distal M1 middle cerebral artery (39/84 [46.4%]) vs internal carotid artery (10/92 [10.9%]) (OR, 5.61 [95% CI, 2.38-13.26]), and higher residual flow (thrombus permeability) grade, eg, hairline streak (30/45 [66.7%]) vs none (91/377 [24.1%]) (OR, 7.03 [95% CI, 3.32-14.87]). CONCLUSIONS AND RELEVANCE: In patients with acute ischemic stroke, more distal thrombus location, greater thrombus permeability, and longer time to recanalization assessment were associated with recanalization of arterial occlusion after administration of intravenous alteplase; among patients who did not receive alteplase, rates of arterial recanalization were low. These findings may help inform treatment and triage decisions in patients with acute ischemic stroke.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>30208455</pmid><doi>10.1001/jama.2018.12498</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 2018-09, Vol.320 (10), p.1017-1026 |
| issn | 0098-7484 1538-3598 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6143104 |
| source | MEDLINE; American Medical Association Journals |
| subjects | Administration, Intravenous Aged Aged, 80 and over Angiography Blood clots Brain Ischemia - drug therapy Brain Ischemia - surgery Cardiovascular system Carotid artery Cerebral blood flow Clinical outcomes Combined Modality Therapy Computed tomography Computed Tomography Angiography Demographics Demography Female Fibrinolytic Agents - therapeutic use Humans Intravenous administration Ischemia Male Medical imaging Middle Aged Occlusion Original Investigation Patients Permeability Prospective Studies Stroke Stroke - diagnostic imaging Stroke - drug therapy Stroke - surgery Thrombectomy Thrombosis Tissue Plasminogen Activator - therapeutic use Treatment Outcome |
| title | Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-30T06%3A18%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Association%20of%20Clinical,%20Imaging,%20and%20Thrombus%20Characteristics%20With%20Recanalization%20of%20Visible%20Intracranial%20Occlusion%20in%20Patients%20With%20Acute%20Ischemic%20Stroke&rft.jtitle=JAMA%20:%20the%20journal%20of%20the%20American%20Medical%20Association&rft.au=Menon,%20Bijoy%20K&rft.aucorp=INTERRSeCT%20Study%20Investigators&rft.date=2018-09-11&rft.volume=320&rft.issue=10&rft.spage=1017&rft.epage=1026&rft.pages=1017-1026&rft.issn=0098-7484&rft.eissn=1538-3598&rft_id=info:doi/10.1001/jama.2018.12498&rft_dat=%3Cproquest_pubme%3E2103675148%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2114675894&rft_id=info:pmid/30208455&rft_ama_id=2702146&rfr_iscdi=true |