Impacts of Rapid Recanalization and Collateral Circulation on Clinical Outcome after Intraarterial Thrombolysis
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background and Purpose Rapid recanalization might improve clinical outcomes after intraarterial thrombolysis (IAT) for acute ischemic stroke patients with collateral circulation. We determined whether rapid recanalization and collateral circulation affect clinical outcomes after IAT. Methods We retrospectively evaluated the clinical and radiological data of 134 consecutive patients who underwent IAT for intracranial artery occlusion. The interval from symptom onset to recanalization after IAT (onset-to-recanalization time) as an estimate of the probability of good clinical outcome (modified Rankin scale 0-2) was calculated in patients with collateral circulation in the ischemic hemisphere, which was rated poor (0/1 American Society of Interventional and Therapeutic Neuroradiology criteria) or good (2-4). Changes in National Institute of Health Stroke Scale (NHISS) score before and after IAT and modified Rankins scale scores 3 months after discharge were compared with respect to onset-to-recanalization time. Results In patients with good collateral circulation, the estimated onset-to-recanalization time for a 0.5 probability of a good clinical outcome was 347 minutes; with poor collateral circulation, it was 172 minutes for a 0.2 probability of good clinical outcome. Outcome analyses according to onset-to-recanalization time showed patients recanalized <6 hours had lower NHISS scores (<4.5, 4.5-6, >6 hours of onset-to-recanalization time, and non-recanalization: 5.1, 6.9, 11.9, and 19.8, respectively) at discharge and higher percentages of good clinical outcome (69%, 66.7%, 21.9%, and 0%, respectively) 3 months after IAT. Conclusions The time window to expect a high probability of a good clinical outcome after IAT is highly dependent on the collateral circulation.
Abstract
Background and Purpose Rapid recanalization might improve clinical outcomes after intraarterial thrombolysis (IAT) for acute ischemic stroke patients with collateral circulation. We determined whether rapid recanalization and collateral circulation affect clinical outcomes after IAT. Methods We retrospectively evaluated the clinical and radiological data of 134 consecutive patients who underwent IAT for intracranial artery occlusion. The interval from symptom onset to recanalization after IAT (onset-to-recanalization time) as an estimate of the probability of good clinical outcome (modified Rankin scale 0-2) was calculated in patients with collateral circulation in the ischemic hemisphere, which was rated poor (0/1 American Society of Interventional and Therapeutic Neuroradiology criteria) or good (2-4). Changes in National Institute of Health Stroke Scale (NHISS) score before and after IAT and modified Rankins scale scores 3 months after discharge were compared with respect to onset-to-recanalization time. Results In patients with good collateral circulation, the estimated onset-to-recanalization time for a 0.5 probability of a good clinical outcome was 347 minutes; with poor collateral circulation, it was 172 minutes for a 0.2 probability of good clinical outcome. Outcome analyses according to onset-to-recanalization time showed patients recanalized <6 hours had lower NHISS scores (<4.5, 4.5-6, >6 hours of onset-to-recanalization time, and non-recanalization: 5.1, 6.9, 11.9, and 19.8, respectively) at discharge and higher percentages of good clinical outcome (69%, 66.7%, 21.9%, and 0%, respectively) 3 months after IAT. Conclusions The time window to expect a high probability of a good clinical outcome after IAT is highly dependent on the collateral circulation.
참고문헌 (20)
- Khatri P, "Good clinical outcome after ischemic stroke with successful revascularization is time-dependent", Neurology, 73, pp.1066~1072 (2009)
- Mazighi M, "Dramatic recovery in acute ischemic stroke is associated with arterial recanalization grade and speed", Stroke, 43, pp.2998~3002 (2012)
- Castaño C, "Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation:a pilot study", Stroke, 41, pp.1836~1840 (2010)
- Smith WS, "Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial", Stroke, 36, pp.1432~1438 (2005)
- Penumbra Pivotal Stroke Trial Investigators, "The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease", Stroke, 40, pp.2761~2768 (2009)
- Broderick JP, "Endovascular therapy after intravenous t-PA versus t-PA alone for stroke", N Engl J Med, 368, pp.893~903 (2013)
- Ciccone A, "Endovascular treatment for acute ischemic stroke", N Engl J Med, 368, pp.904~913 (2013)
- Kidwell CS, "A trial of imaging selection and endovascular treatment for ischemic stroke", N Engl J Med, 368, pp.914~923 (2013)
- Rha JH, "The impact of recanalization on ischemic stroke outcome: a meta-analysis", Stroke, 38, pp.967~973 (2007)
- Marks MP, "Effect of collateral blood flow on patients undergoing endovascular therapy for acute ischemic stroke", Stroke, 45, pp.1035~1039 (2014)
- Brott T, "Measurements of acute cerebral infarction: a clinical examination scale", Stroke, 20, pp.864~870 (1989)
- 정혜선, "A Comparison of Stent-Assisted Mechanical Thrombectomy and Conventional Intra-Arterial Thrombolysis for Acute Cerebral Infarction", Journal of Clinical Neurology, 9(2), pp.91~96 (2013), 대한신경과학회[DOI]
- Sorimachi T, "Recanalization by mechanical embolus disruption during intra-arterial thrombolysis in the carotid territory", Am J Neuroradiol, 25, pp.1391~1402 (2004)
- Higashida RT, "Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke", Stroke, 34, pp.e109~137 (2003)
- Roth C, "Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions", Stroke, 41, pp.2559~2567 (2010)
- Bang OY, "Impact of collateral flow on tissue fate in acute ischaemic stroke", J Neurol Neurosurg Psychiatry, 79, pp.625~629 (2008)
- Khatri P, "Intracerebral hemorrhage associated with revascularization therapies", Stroke, 38, pp.431~440 (2007)
- Christoforidis GA, "Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke", Am J Neuroradiol, 26, pp.1789~1797 (2005)
- Khatri P, "Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III)phase 3 trial", Lancet Neurol, 13, pp.567~574 (2014)
- Mokin M, "Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion:a systematic review of clinical outcomes", Stroke, 43, pp.2362~2368 (2012)