Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study
Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with "futile recanalization," defined by absence of clinical benefit from recanaliza...
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| Veröffentlicht in: | American journal of neuroradiology : AJNR 2010-03, Vol.31 (3), p.454-458 |
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| creator | HUSSEIN, H. M GEORGIADIS, A. L VAZQUEZ, G MILEY, J. T MEMON, M. Z MOHAMMAD, Y. M CHRISTOFORIDIS, G. A TARIQ, N QURESHI, A. I |
| description | Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with "futile recanalization," defined by absence of clinical benefit from recanalization, following endovascular treatment of acute ischemic stroke.
Data from 6 studies of acute ischemic stroke treated with mechanical and/or pharmacologic endovascular treatment were analyzed. "Futile recanalization" was defined by the occurrence of unfavorable outcome (mRS score of > or = 3 at 1-3 months) despite complete angiographic recanalization (Qureshi grade 0 or TIMI grade 3).
Complete recanalization was observed in 96 of 270 patients treated with IA thrombolysis. Futile recanalization was observed in 47 (49%). In univariate analysis, patients with futile recanalization were older (73 +/- 11 versus 58 +/- 15 years, P < .0001) and had higher median initial NIHSS scores (19 versus 14, P < .0001), more frequent BA occlusion (17% versus 4%, P = .049), less frequent MCA occlusion (53% versus 76%, P = .032), and a nonsignificantly higher rate of symptomatic hemorrhagic complications (2% versus 9%, P = .2). In logistic regression analysis, futile recanalization was positively associated with age > 70 years (OR, 4.4; 95% CI, 1.9-10.5; P = .0008) and initial NIHSS score 10-19 (OR, 3.8; 95% CI, 1.7-8.4; P = .001), and initial NIHSS score > or = 20 (OR, 64.4; 95% CI, 28.8-144; P < .0001).
Futile recanalization is a relatively common occurrence following endovascular treatment, particularly among elderly patients and those with severe neurologic deficits. |
| doi_str_mv | 10.3174/ajnr.A2006 |
| format | Article |
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Data from 6 studies of acute ischemic stroke treated with mechanical and/or pharmacologic endovascular treatment were analyzed. "Futile recanalization" was defined by the occurrence of unfavorable outcome (mRS score of > or = 3 at 1-3 months) despite complete angiographic recanalization (Qureshi grade 0 or TIMI grade 3).
Complete recanalization was observed in 96 of 270 patients treated with IA thrombolysis. Futile recanalization was observed in 47 (49%). In univariate analysis, patients with futile recanalization were older (73 +/- 11 versus 58 +/- 15 years, P < .0001) and had higher median initial NIHSS scores (19 versus 14, P < .0001), more frequent BA occlusion (17% versus 4%, P = .049), less frequent MCA occlusion (53% versus 76%, P = .032), and a nonsignificantly higher rate of symptomatic hemorrhagic complications (2% versus 9%, P = .2). In logistic regression analysis, futile recanalization was positively associated with age > 70 years (OR, 4.4; 95% CI, 1.9-10.5; P = .0008) and initial NIHSS score 10-19 (OR, 3.8; 95% CI, 1.7-8.4; P = .001), and initial NIHSS score > or = 20 (OR, 64.4; 95% CI, 28.8-144; P < .0001).
Futile recanalization is a relatively common occurrence following endovascular treatment, particularly among elderly patients and those with severe neurologic deficits.</description><identifier>ISSN: 0195-6108</identifier><identifier>EISSN: 1936-959X</identifier><identifier>DOI: 10.3174/ajnr.A2006</identifier><identifier>PMID: 20075087</identifier><identifier>CODEN: AAJNDL</identifier><language>eng</language><publisher>Oak Brook, IL: American Society of Neuroradiology</publisher><subject>Acute Disease ; Adult ; Age Distribution ; Aged ; Biological and medical sciences ; Brain Ischemia - diagnostic imaging ; Brain Ischemia - drug therapy ; Brain Ischemia - epidemiology ; Cerebral Revascularization - statistics & numerical data ; Clinical Trials as Topic - statistics & numerical data ; Female ; Fundamental and applied biological sciences. Psychology ; Human ; Humans ; Interventional ; Investigative techniques, diagnostic techniques (general aspects) ; Learning. Memory ; Male ; Medical Futility ; Medical sciences ; Memory ; Middle Aged ; Multivariate Analysis ; Nervous system ; Predictive Value of Tests ; Psychology. Psychoanalysis. Psychiatry ; Psychology. Psychophysiology ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Radiography ; Retreatment ; Risk Factors ; Stroke - diagnostic imaging ; Stroke - drug therapy ; Stroke - epidemiology ; Thrombolytic Therapy - statistics & numerical data ; Treatment Failure</subject><ispartof>American journal of neuroradiology : AJNR, 2010-03, Vol.31 (3), p.454-458</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright © American Society of Neuroradiology 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c407t-5b8e2bd755ee5b4a5caf6060edab212faa76e62298079dbecb59a16be71040833</citedby><cites>FETCH-LOGICAL-c407t-5b8e2bd755ee5b4a5caf6060edab212faa76e62298079dbecb59a16be71040833</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7963981/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7963981/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22576547$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20075087$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HUSSEIN, H. M</creatorcontrib><creatorcontrib>GEORGIADIS, A. L</creatorcontrib><creatorcontrib>VAZQUEZ, G</creatorcontrib><creatorcontrib>MILEY, J. T</creatorcontrib><creatorcontrib>MEMON, M. Z</creatorcontrib><creatorcontrib>MOHAMMAD, Y. M</creatorcontrib><creatorcontrib>CHRISTOFORIDIS, G. A</creatorcontrib><creatorcontrib>TARIQ, N</creatorcontrib><creatorcontrib>QURESHI, A. I</creatorcontrib><title>Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study</title><title>American journal of neuroradiology : AJNR</title><addtitle>AJNR Am J Neuroradiol</addtitle><description>Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with "futile recanalization," defined by absence of clinical benefit from recanalization, following endovascular treatment of acute ischemic stroke.
Data from 6 studies of acute ischemic stroke treated with mechanical and/or pharmacologic endovascular treatment were analyzed. "Futile recanalization" was defined by the occurrence of unfavorable outcome (mRS score of > or = 3 at 1-3 months) despite complete angiographic recanalization (Qureshi grade 0 or TIMI grade 3).
Complete recanalization was observed in 96 of 270 patients treated with IA thrombolysis. Futile recanalization was observed in 47 (49%). In univariate analysis, patients with futile recanalization were older (73 +/- 11 versus 58 +/- 15 years, P < .0001) and had higher median initial NIHSS scores (19 versus 14, P < .0001), more frequent BA occlusion (17% versus 4%, P = .049), less frequent MCA occlusion (53% versus 76%, P = .032), and a nonsignificantly higher rate of symptomatic hemorrhagic complications (2% versus 9%, P = .2). In logistic regression analysis, futile recanalization was positively associated with age > 70 years (OR, 4.4; 95% CI, 1.9-10.5; P = .0008) and initial NIHSS score 10-19 (OR, 3.8; 95% CI, 1.7-8.4; P = .001), and initial NIHSS score > or = 20 (OR, 64.4; 95% CI, 28.8-144; P < .0001).
Futile recanalization is a relatively common occurrence following endovascular treatment, particularly among elderly patients and those with severe neurologic deficits.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Age Distribution</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Brain Ischemia - diagnostic imaging</subject><subject>Brain Ischemia - drug therapy</subject><subject>Brain Ischemia - epidemiology</subject><subject>Cerebral Revascularization - statistics & numerical data</subject><subject>Clinical Trials as Topic - statistics & numerical data</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Human</subject><subject>Humans</subject><subject>Interventional</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Learning. Memory</subject><subject>Male</subject><subject>Medical Futility</subject><subject>Medical sciences</subject><subject>Memory</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Nervous system</subject><subject>Predictive Value of Tests</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychology. Psychophysiology</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Radiography</subject><subject>Retreatment</subject><subject>Risk Factors</subject><subject>Stroke - diagnostic imaging</subject><subject>Stroke - drug therapy</subject><subject>Stroke - epidemiology</subject><subject>Thrombolytic Therapy - statistics & numerical data</subject><subject>Treatment Failure</subject><issn>0195-6108</issn><issn>1936-959X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpV0VFrFDEQB_BFFHutvvgBJC8iCFuT7GWz8UE4SquFSotW8C3MZmd7qdmkJtmW9mP4ic3Zs-pTSObHZJh_Vb1gdL9hcvkWLn3cX3FK20fVgqmmrZVQ3x5XC8qUqFtGu51qN6VLSqlQkj-tdoqVgnZyUf08NWaOEb1BAn4gZxEHa3KIiYSRHM3ZOiSf0YAHZ-8g2-DJGJwLN9ZfkEM_hGtIZnYQyXlEyBP6TGAKpXhWdLklcmPzmqzMnJEcJ7PGyRryJcfwHd-RFfk0u2xNgRjL6zzcPquejOASPt-ee9XXo8Pzg4_1yemH44PVSW2WVOZa9B3yfpBCIIp-CcLA2NKW4gA9Z3wEkC22nKuOSjX0aHqhgLU9SkaXtGuaver9fd-ruZ9w2IwQwemraCeItzqA1f9XvF3ri3CtpWob1bHS4PW2QQw_ZkxZTzYZdA48hjlp2TRcCK5UkW_upYkhpYjjwy-M6k2GepOh_p1hwS__neuB_gmtgFdbUFYPbozgjU1_HReyFUvZ_ALY2Kni</recordid><startdate>20100301</startdate><enddate>20100301</enddate><creator>HUSSEIN, H. 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I</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study</atitle><jtitle>American journal of neuroradiology : AJNR</jtitle><addtitle>AJNR Am J Neuroradiol</addtitle><date>2010-03-01</date><risdate>2010</risdate><volume>31</volume><issue>3</issue><spage>454</spage><epage>458</epage><pages>454-458</pages><issn>0195-6108</issn><eissn>1936-959X</eissn><coden>AAJNDL</coden><abstract>Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with "futile recanalization," defined by absence of clinical benefit from recanalization, following endovascular treatment of acute ischemic stroke.
Data from 6 studies of acute ischemic stroke treated with mechanical and/or pharmacologic endovascular treatment were analyzed. "Futile recanalization" was defined by the occurrence of unfavorable outcome (mRS score of > or = 3 at 1-3 months) despite complete angiographic recanalization (Qureshi grade 0 or TIMI grade 3).
Complete recanalization was observed in 96 of 270 patients treated with IA thrombolysis. Futile recanalization was observed in 47 (49%). In univariate analysis, patients with futile recanalization were older (73 +/- 11 versus 58 +/- 15 years, P < .0001) and had higher median initial NIHSS scores (19 versus 14, P < .0001), more frequent BA occlusion (17% versus 4%, P = .049), less frequent MCA occlusion (53% versus 76%, P = .032), and a nonsignificantly higher rate of symptomatic hemorrhagic complications (2% versus 9%, P = .2). In logistic regression analysis, futile recanalization was positively associated with age > 70 years (OR, 4.4; 95% CI, 1.9-10.5; P = .0008) and initial NIHSS score 10-19 (OR, 3.8; 95% CI, 1.7-8.4; P = .001), and initial NIHSS score > or = 20 (OR, 64.4; 95% CI, 28.8-144; P < .0001).
Futile recanalization is a relatively common occurrence following endovascular treatment, particularly among elderly patients and those with severe neurologic deficits.</abstract><cop>Oak Brook, IL</cop><pub>American Society of Neuroradiology</pub><pmid>20075087</pmid><doi>10.3174/ajnr.A2006</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Adult Age Distribution Aged Biological and medical sciences Brain Ischemia - diagnostic imaging Brain Ischemia - drug therapy Brain Ischemia - epidemiology Cerebral Revascularization - statistics & numerical data Clinical Trials as Topic - statistics & numerical data Female Fundamental and applied biological sciences. Psychology Human Humans Interventional Investigative techniques, diagnostic techniques (general aspects) Learning. Memory Male Medical Futility Medical sciences Memory Middle Aged Multivariate Analysis Nervous system Predictive Value of Tests Psychology. Psychoanalysis. Psychiatry Psychology. Psychophysiology Radiodiagnosis. Nmr imagery. Nmr spectrometry Radiography Retreatment Risk Factors Stroke - diagnostic imaging Stroke - drug therapy Stroke - epidemiology Thrombolytic Therapy - statistics & numerical data Treatment Failure |
| title | Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study |
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