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Efficacy and Limitations of Multimodal Endovascular Revascularization Other than Clot Retrieval for Acute Stroke Caused by Large-vessel Occlusion.
MedLine Citation:
PMID:  22818387     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The purpose of this study was to evaluate the efficacy of multimodal endovascular treatment (EVT) other than clot retrieval for acute large-vessel occlusion (LVO). METHODS: Fifty-six consecutive patients with a median National Institutes of Health Stroke Scale (NIHSS) score of 15 were included this study. In all cases, intravenous administration of recombinant tissue plasminogen activator had failed (n = 23) or was contraindicated (n = 33). The modes of EVT performed included intra-arterial thrombolysis, mechanical clot disruption including balloon angioplasty, and stent placement. We retrospectively analyzed the treatment efficacy of these techniques and patient outcome. RESULTS: Successful reperfusion (Thrombolysis in Cerebral Infarction grade 2B or 3) was achieved in 40 of 56 patients (71.4%), and 26 of 56 patients (46.4%) had a favorable clinical outcome (modified Rankin Scale [mRS] score 0 to 2 at 90 days). Successful reperfusion (odds ratio [OR] 163; P = .003), age (OR 0.83; P = .007), and baseline NIHSS score (OR 0.71; P = .009) were independently associated with favorable clinical outcome by multivariate analysis. Successful reperfusion rates of internal carotid terminus or M1 proximal occlusions were significantly lower than those of other vessel occlusion (47.6% v 85.7%; P = .005). Clinically significant procedure-related complications occurred in 1.8% (1/56), and symptomatic intracerebral hemorrhage (sICH) within 48 hours after EVT was observed in 5.4% (3/56) of patients. CONCLUSIONS: Multimodal EVT for acute LVO yields a high reperfusion rate with a minimal risk of sICH and contributes to favorable patient outcomes. These techniques should be considered when clot retrieval is unsuitable or ineffective.
Authors:
Yusuke Egashira; Shinichi Yoshimura; Yukiko Enomoto; Mitsunori Ishiguro; Kiyofumi Yamada; Yoshitaka Tanaka; Toru Iwama
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-17
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  -     ISSN:  1532-8511     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.
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