Document Detail


Occurrence and predictors of futile recanalization following endovascular treatment among patients with acute ischemic stroke: a multicenter study.
MedLine Citation:
PMID:  20075087     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with "futile recanalization," defined by absence of clinical benefit from recanalization, following endovascular treatment of acute ischemic stroke.
MATERIALS AND METHODS: Data from 6 studies of acute ischemic stroke treated with mechanical and/or pharmacologic endovascular treatment were analyzed. "Futile recanalization" was defined by the occurrence of unfavorable outcome (mRS score of > or = 3 at 1-3 months) despite complete angiographic recanalization (Qureshi grade 0 or TIMI grade 3).
RESULTS: Complete recanalization was observed in 96 of 270 patients treated with IA thrombolysis. Futile recanalization was observed in 47 (49%). In univariate analysis, patients with futile recanalization were older (73 +/- 11 versus 58 +/- 15 years, P < .0001) and had higher median initial NIHSS scores (19 versus 14, P < .0001), more frequent BA occlusion (17% versus 4%, P = .049), less frequent MCA occlusion (53% versus 76%, P = .032), and a nonsignificantly higher rate of symptomatic hemorrhagic complications (2% versus 9%, P = .2). In logistic regression analysis, futile recanalization was positively associated with age > 70 years (OR, 4.4; 95% CI, 1.9-10.5; P = .0008) and initial NIHSS score 10-19 (OR, 3.8; 95% CI, 1.7-8.4; P = .001), and initial NIHSS score > or = 20 (OR, 64.4; 95% CI, 28.8-144; P < .0001).
CONCLUSIONS: Futile recanalization is a relatively common occurrence following endovascular treatment, particularly among elderly patients and those with severe neurologic deficits.
Authors:
H M Hussein; A L Georgiadis; G Vazquez; J T Miley; M Z Memon; Y M Mohammad; G A Christoforidis; N Tariq; A I Qureshi
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2010-01-14
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  31     ISSN:  1936-959X     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-16     Completed Date:  2010-06-10     Revised Date:  2011-12-20    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  454-8     Citation Subset:  IM    
Affiliation:
Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota, USA. husseihm@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Age Distribution
Aged
Brain Ischemia / drug therapy*,  epidemiology*,  radiography
Cerebral Revascularization / statistics & numerical data,  utilization*
Clinical Trials as Topic / statistics & numerical data
Female
Humans
Male
Medical Futility
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Retreatment
Risk Factors
Stroke / drug therapy*,  epidemiology*,  radiography
Thrombolytic Therapy / statistics & numerical data,  utilization*
Treatment Failure
Comments/Corrections
Comment In:
AJNR Am J Neuroradiol. 2011 Nov;32(10):1769-70   [PMID:  21940806 ]

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