Document Detail


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
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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.
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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


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