Document Detail


Symptomatic delayed reocclusion after initial successful revascularization in acute ischemic stroke.
MedLine Citation:
PMID:  20123225     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Endovascular stroke therapy is used for patients with ischemic stroke after failed intravenous thrombolysis or in patients not eligible for thrombolytics. With increasing experience, acute reocclusion has been described and likely worsens clinical outcomes. We assessed the rates and outcomes of delayed symptomatic reocclusion after endovascular therapy for acute ischemic stroke. METHODS: Patients with acute ischemic stroke undergoing endovascular procedures at out institutions from January 2008 to August 2008 were reviewed. In all, 107 consecutive acute stroke interventions were performed. Four patients (3.5%) experienced delayed symptomatic reocclusion detectable by the National Institutes of Health Stroke Scale (NIHSS). RESULTS: The 4 patients (age 45-79 years) had baseline NIHSS score ranging from 8 to 24. Three had right middle cerebral artery occlusions and one had a left middle cerebral artery occlusion. Successful recanalization (thrombolysis in myocardial infarction score 2-3) occurred in all cases after initial treatment. All patients improved postprocedure (NIHSS score 5-10). Clinical deterioration (NIHSS score 14-22) occurred 12 to 18 hours postprocedure. Successful recanalization was achieved in each patient, with improvement in NIHSS score (range 6-13) but not to a lower level compared with after the initial intervention. CONCLUSIONS: Delayed symptomatic reocclusion after initial endovascular stroke therapy can lead to sudden clinical deterioration and impact outcomes. The entity may be missed as many patients present with large clinical deficits at presentation thus requiring careful assessments of patients treated via endovascular methods.
Authors:
Muhammad S Hussain; Ridwan Lin; Shaye Moskowitz; Mark Bain; Vivekananda Gonugunta; Peter A Rasmussen; Thomas J Masaryk; Michael B Horowitz; Tudor Jovin; Rishi Gupta
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Publication Detail:
Type:  Case Reports; Journal Article; Multicenter Study    
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  19     ISSN:  1532-8511     ISO Abbreviation:  J Stroke Cerebrovasc Dis     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2010-04-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  36-9     Citation Subset:  IM    
Copyright Information:
(c) 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Affiliation:
Cerebrovascular Center, Cleveland Clinic Foundation, Ohio 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Angioplasty, Balloon / instrumentation
Brain Ischemia / complications,  radiography,  therapy*
Cerebral Angiography
Cerebral Revascularization* / instrumentation,  methods
Female
Humans
Infarction, Middle Cerebral Artery / etiology,  radiography,  therapy*
Magnetic Resonance Angiography
Middle Aged
Platelet Aggregation Inhibitors / therapeutic use
Recurrence
Retrospective Studies
Severity of Illness Index
Stents
Thrombolytic Therapy
Time Factors
Treatment Outcome
United States
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors

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