| Mechanical approaches combined with intra-arterial pharmacological therapy are associated with higher recanalization rates than either intervention alone in revascularization of acute carotid terminus occlusion. | |
| | |
MedLine Citation:
|
PMID: 19390066 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND AND PURPOSE: Acute stroke attributable to internal carotid artery terminus occlusion carries a poor prognosis. Vessel recanalization is crucial to improve clinical outcome. Historically, pharmacological thrombolysis alone has low recanalization rates. We sought to determine whether adjunctive mechanical approaches achieve better vessel recanalization and functional outcome. METHODS: We retrospectively reviewed 75 consecutive endovascular cases of acute internal carotid artery terminus occlusions treated at our center between 1998 and 2008. Mechanical approaches (MERCI retrieval/angioplasty/stent) with and without adjunctive intra-arterial pharmacological therapy (urokinase or tissue plasminogen activator) was compared to intra-arterial lytics alone. Univariate and multivariate analyses were performed to determine predictors of recanalization (thrombolysis in myocardial infarction grades 2 to 3) and favorable functional outcome (modified Rankin score <or=2) at 3 months. RESULTS: Lowest recanalization rates were observed with intra-arterial lytics alone (3/17, 17.6%). MERCI embolectomy combined with intra-arterial lytics was associated with the highest recanalization rates (18/21, 85.7%; P<0.0001). MERCI embolectomy alone achieved 46.2% recanalization rates (6/13; P=0.23). Angioplasty or stenting and intra-arterial lytics achieved 25% (2/8; P=0.65) and 40% (4/10; P=0.085) recanalization, respectively. In multivariate analysis, combination of MERCI embolectomy with intra-arterial lytics (OR, 16.2; CI, 4.6-77.6), or any mechanical technique with intra-arterial lytics (OR, 6.7; CI, 2.5-19.5) independently predicted thrombolysis in myocardial infarction 2 to 3 recanalization. Clinically significant parenchymal hemorrhage rates were 7.5% with combination (3/38) and 12.5% with pharmacological therapies (2/16; P=0.46). Using stepwise logistic regression, age (OR, 0.95; CI, 0.90-0.995), baseline NIHSS (OR, 0.82; CI, 0.70-0.96), and thrombolysis in myocardial infarction 2 to 3 recanalization (OR, 4.0; CI, 1.1-14.4) were associated with favorable functional outcome. CONCLUSIONS: Combined mechanical and intra-arterial pharmacological therapy is associated with higher recanalization rates than either intervention alone in acute internal carotid artery terminus occlusion revascularization. |
| | |
Authors:
|
Ridwan Lin; Nirav Vora; Syed Zaidi; Aitziber Aleu; Brian Jankowitz; Ajith Thomas; Rishi Gupta; Michael Horowitz; Susan Kim; Vivek Reddy; Maxim Hammer; Ken Uchino; Lawrence R Wechsler; Tudor Jovin |
Related Documents
:
|
758896 - Blindness secondary to steroid injections into the nasal turbinates. 8402106 - Acute limb deterioration during intra-arterial thrombolysis. 18649116 - Development of a new orthotopic animal model of metastatic liver cancer in the rabbit v... 20023546 - Effect of vasodilation by milrinone, a phosphodiesterase iii inhibitor, on vasospastic ... 19804206 - Remote endarterectomy for occlusive iliac and superficial femoral artery disease. 22757506 - Three-dimensional geometry of the human carotid artery. |
Publication Detail:
|
Type: Journal Article Date: 2009-04-23 |
Journal Detail:
|
Title: Stroke; a journal of cerebral circulation Volume: 40 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2009 Jun |
Date Detail:
|
Created Date: 2009-05-25 Completed Date: 2009-06-12 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
|
Languages: eng Pagination: 2092-7 Citation Subset: IM |
Affiliation:
|
Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pittsburgh, PA 15213, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Acute Disease Aged Angioplasty Carotid Artery Diseases / complications, drug therapy*, therapy* Combined Modality Therapy Female Humans Male Middle Aged Myocardial Infarction / drug therapy, pathology Neurosurgical Procedures Plasminogen Activators / therapeutic use Retrospective Studies Stents Stroke / drug therapy*, etiology, therapy* Thrombolytic Therapy* Treatment Outcome Urokinase-Type Plasminogen Activator / therapeutic use |
| Chemical | |
Reg. No./Substance:
|
EC 3.4.21.-/Plasminogen Activators; EC 3.4.21.73/Urokinase-Type Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Dispatcher recognition of stroke using the national academy medical priority dispatch system.
Next Document: A randomized controlled trial of mental imagery augment generalization of learning in acute poststro...