Document Detail


Multimodal reperfusion therapy for acute ischemic stroke: factors predicting vessel recanalization.
MedLine Citation:
PMID:  16527997     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Endovascular therapies using mechanical and pharmacological modalities for large vessel occlusions in acute stroke are rapidly evolving. Our aim was to determine whether one modality is associated with higher recanalization rates. METHODS: We retrospectively reviewed 168 consecutive patients treated with intra-arterial (IA) therapy for acute ischemic stroke between May 1999 and November 15, 2005. Demographic, clinical, radiographic, angiographic, and procedural notes were reviewed. Recanalization was defined as achieving thrombolysis in myocardial infarction 2 or 3 flow after intervention. A logistic regression model was constructed to determine independent predictors of successful recanalization. RESULTS: A total of 168 patients were reviewed with a mean age of 64+/-13 years and mean National Institutes of Health Stroke Scale score of 17+/-4. Recanalization was achieved in 106 (63%) patients. Independent predictors of recanalization include: the combination of IA thrombolytics and glycoprotein IIb/IIIa inhibitors (odds ratio [OR], 2.9 [95% CI, 1.04 to 6.7]; P<0.048), intracranial stent placement with angioplasty (OR, 4.8 [95% CI, 1.8 to 10.0]; P<0.001), or extracranial stent placement with angioplasty (OR, 4.2 [95% CI, 1.4 to 9.8]; P<0.014). Lesions at the terminus of the internal carotid artery were recalcitrant to revascularization (OR, 0.34 [95% CI, 0.16 to 0.73]; P value 0.006). CONCLUSIONS: Intracranial or extracranial stenting or combination therapy with IA thrombolytics and glycoprotein IIb/IIIa inhibitors in the setting of multimodal therapy is associated with successful recanalization in patients treated with multimodal endovascular reperfusion therapy for acute ischemic stroke.
Authors:
Rishi Gupta; Nirav A Vora; Michael B Horowitz; Ashis H Tayal; Maxim D Hammer; Ken Uchino; Elad I Levy; Lawrence R Wechsler; Tudor G Jovin
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2006-03-09
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  37     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-03-28     Completed Date:  2006-04-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  986-90     Citation Subset:  IM    
Affiliation:
Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pennsylvania, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Brain Ischemia / complications*
Cohort Studies
Fibrinolytic Agents / administration & dosage,  therapeutic use
Humans
Injections, Intra-Arterial
Middle Aged
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Prognosis
Reperfusion / methods*,  standards
Retrospective Studies
Severity of Illness Index
Stents
Stroke / etiology*,  physiopathology,  therapy*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Platelet Glycoprotein GPIIb-IIIa Complex

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