Refining Angiographic Biomarkers of Revascularization

Yoo, Albert J.; Simonsen, Claus Z; Prabhakaran, Shyam; Chaudhry, Zeshan A.; Issa, Mohammad A.; Fugate, Jennifer E.; Linfante, Italo; Liebeskind, David S; Khatri, Pooja; Jovin, Tudor G; Kallmes, David F.; Dabus, Guilherme; Zaidat, Osama O.

doi:10.1161/strokeaha.113.001990

Cited by 176 publications

(94 citation statements)

References 15 publications

(19 reference statements)

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“…11 Although not significant, Yoo et al likewise observed a higher rate of good functional outcomes (mRS of 0-2 at $90 days) in patients with a TICI 3 grade compared with patients with a TICI 2b grade (62% vs. 46%). 12 The present results are in agreement with the results of these prior studies.…”

Section: Discussionsupporting

confidence: 94%

Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

Tajima

Hayasaka

Ebihara

et al. 2017

J Clin Interv Radiol ISVIR

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Successful revascularization is one of the main predictors of a favorable clinical outcome after mechanical thrombectomy. However, even if mechanical thrombectomy is successful, some patients have a poor clinical outcome. This study aimed to investigate the clinical, imaging, and procedural factors that are predictive of poor clinical outcomes despite successful revascularization after mechanical thrombectomy in patients with acute anterior circulation stroke. The authors evaluated 69 consecutive patients (mean age, 74.6 years, 29 women) who presented with acute ischemic stroke due to internal cerebral artery or middle cerebral artery occlusions and who were successfully treated with mechanical thrombectomy between July 2014 and November 2016. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months after treatment. The associations between the clinical, imaging, and procedural factors and poor outcome were evaluated using logistic regression analyses. Using multivariate analyses, the authors found that the preoperative National Institute of Health Stroke Scale (NIHSS) score (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.004–1.325; p = 0.028), the diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) (OR, 0.604; 95% CI, 0.412–0.882; p = 0.003), and a Thrombolysis in Cerebral Infarction (TICI) 2b classification (OR, 4.521; 95% CI, 1.140–17.885; p = 0.026) were independent predictors of poor outcome. Complete revascularization to reduce the infarct volume should be performed, especially in patients with a high DWI-ASPECTS, to increase the likelihood of a good outcome.

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Section: Discussionsupporting

confidence: 94%

Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

Tajima

Hayasaka

Ebihara

et al. 2017

J Clin Interv Radiol ISVIR

View full text Add to dashboard Cite

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“…This may have further reduced the odds for better clinical outcomes as a reperfusion result of mTICI >2b is prognostic for good clinical outcome (Yoo et al. 2013). …”

Section: Discussionmentioning

confidence: 99%

“…EVT was halted when successful reperfusion defined as modified Treatment in Cerebral Ischemia (mTICI) 2b or 3 (Yoo et al. 2013) was confirmed or if reperfusion could not be achieved within 2 h (Broderick et al. 2013).…”

Section: Methodsmentioning

confidence: 99%

“…2011; Yoo et al. 2013). Due to a lack of published data, we dichotomized the variable CT‐CS based on a nonparametric Kruskal–Wallis one‐way analysis of variance.…”

Section: Methodsmentioning

confidence: 99%

“…Besides collateral status, recanalization is strongly associated with improved functional outcomes and reduced mortality (Rha and Saver 2007), more specifically, substantial angiographic reperfusion seems to be the best predictor for independence after 3 months (Yoo et al. 2013). The combined effect of reperfusion and pretreatment CTA‐collateral status regarding clinical outcome has been evaluated in ischemic stroke patients treated with IVT (Miteff et al.…”

Section: Introductionmentioning

confidence: 99%

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Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

et al. 2016

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PurposeClinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.MethodsIn our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT‐CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data‐driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.ResultsSuccessful angiographic reperfusion (OR 26.50; 95%‐CI 9.33–83.61) and good collaterals (OR 9.69; 95%‐CI 2.28–59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%‐CI 0.14–0.85), younger age (OR 0.88; 95%‐CI 0.83–0.92) and higher NCCT ASPECTS (OR 2.54; 95%‐CI 1.01–6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.Conclusions CTA‐collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA‐collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA‐collaterals.

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Association of Time From Stroke Onset to Groin Puncture With Quality of Reperfusion After Mechanical Thrombectomy

et al. 2019

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; for the HERMES Trialists Collaboration IMPORTANCE Reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) for large-vessel intracranial occlusion. However, data are scarce on the association between the time from onset and reperfusion results. OBJECTIVE To analyze the rate of reperfusion after EVT started at different intervals after symptom onset in patients with AIS. DESIGN, SETTING, AND PARTICIPANTS We conducted a meta-analysis of individual patient data from 7 randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group. This is a multicenter cohort study of the intervention arm of randomized clinical trials included in the HERMES group. Patients with anterior circulation AIS who underwent EVT for M1/M2 or intracranial carotid artery occlusion were included. Each trial enrolled patients according to its specific inclusion and exclusion criteria. Data on patients eligible but not enrolled (eg, refusals or exclusions) were not available. All analyses were performed by the HERMES biostatistical core laboratory using the pooled database. Data were analyzed between December 2010 and April 2015. MAIN OUTCOMES AND MEASURES Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score of 2b/3 at the end of the EVT procedure adjusted for age, occlusion location, pretreatment intravenous thrombolysis, and clot burden score and was analyzed in relation to different intervals (onset, emergency department arrival, imaging, and puncture) using mixed-methods logistic regression. RESULTS Among the 728 included patients, with a mean (SD) age of 65.4 (13.5) years and of whom 345 were female (47.4%), decreases in rates of successful reperfusion defined as a thrombolysis in cerebral infarction score of 2b/3 were observed with increasing time from admission or first imaging to groin puncture. The magnitude of effect was a 22% relative reduction (odds ratio, 0.78; 95% CI, 0.64-0.95) per additional hour between admission and puncture and a 26% relative reduction (odds ratio, 0.74; 95% CI, 0.59-0.93) per additional hour between imaging and puncture. CONCLUSIONS AND RELEVANCE Because the probability of reperfusion declined significantly with time between hospital arrival and groin puncture, we provide additional arguments for minimizing the intervals after symptom onset in anterior circulation acute ischemic stroke.

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Refining Angiographic Biomarkers of Revascularization

Cited by 176 publications

References 15 publications

Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

Association of Time From Stroke Onset to Groin Puncture With Quality of Reperfusion After Mechanical Thrombectomy

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