Recanalization Therapy for Internal Carotid Artery Occlusion Presenting as Acute Ischemic Stroke

Hong, Jeong Ho; Kang, Jihoon; Jang, Min Uk; Kim, Beom Joon; Han, Moon Ku; Park, Tai Hwan; Park, Sang Soon; Lee, Kyung Bok; Lee, Byung Chul; Yu, Kyung Ho; Oh, Mi Sun; Kwan, Jae; Kim, Dae Hyun; Lee, Jun; Lee, Soo Joo; Ko, Young Hwii; Park, Jong‐Moo; Kang, Kyusik; Cho, Yong Jin; Hong, Keun Sik; Cho, Ki-Hyun; Kim, Joon Tae; Lee, Jun-Young; Lee, Ji Sung; Bae, Hee Joon

doi:10.1016/j.jstrokecerebrovasdis.2014.04.025

Cited by 8 publications

(4 citation statements)

References 32 publications

(24 reference statements)

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“…After duplicates had been removed and abstracts screened, nine studies were left. Through comprehensive reading, four studies were excluded due to: (1)an absence of a control group[ 11 – 12 ], (2)more other endovascular treatments than MT and unobtainable detailed data from authors[ 13 ], and (3)the purposeful exclusion of thrombolysis from medical treatment[ 14 ] ( Fig 1 ). Five studies[ 6 – 10 ] including a total of 581 patients met our inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

Endovascular thrombectomy versus medical treatment for large vessel occlusion stroke with mild symptoms: A meta-analysis

et al. 2018

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It remains controversial as to whether mechanical thrombectomy (MT) is safer and more beneficial in patients with large vessel occlusion stroke (LVOS) presenting with a National Institutes of Health Stroke Scale score ≤ 8. We therefore conducted a meta-analysis of the published data.We searched PubMed and Embase and pooled relevant data in the meta-analyses using fixed effects models. Only studies that directly compared best medical therapy alone (BMT) with MT were included. We used odds ratios to analyze the associations between MT and 90-day functional outcome (evaluated using the modified Rankin Scale (mRS)), mortality, and rates of symptomatic intracerebral hemorrhage (sICH) in patients with LVOS and minor symptoms. Five studies including a total of 581 patients met our inclusion criteria. A significant difference was found that the patients treated with MT were associated with improved 90-day mRS score (OR, 1.68; 95% CI, 1.08–2.61) compared with BMT group. There was no difference in 90-day mortality between the two groups. However, sICH occurred more frequently in the MT group than the BMT group (OR, 3.89; 95% CI, 1.83–8.27). Patients with LVOS with minor or mild symptoms who underwent primary thrombectomy had a significantly improved 90-day mRS score compared to those who received BMT alone. Meanwhile, the risk of sICH was higher in the MT group than that in BMT group. Future randomized clinical controlled trials evaluating the role of endovascular reperfusion for LVOS with minimal symptoms are warranted.

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Section: Resultsmentioning

confidence: 99%

Endovascular thrombectomy versus medical treatment for large vessel occlusion stroke with mild symptoms: A meta-analysis

et al. 2018

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“…The technical details of the procedure have been previously reported. [15,29] Briefly, patients received intravenous heparin infusion at the start of the procedure and intermittently thereafter. After successful placement of the guiding catheter, distal embolic protective devices and/or proximal ballooning before stent deployment were employed.…”

Section: Methodsmentioning

confidence: 99%

Residual stenosis after carotid artery stenting: Effect on periprocedural and long-term outcomes

Kang¹,

Hong²,

Kim³

et al. 2019

PLoS ONE

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ObjectiveThis study investigated the effect of residual stenosis after carotid artery stenting (CAS) on periprocedural and long-term outcomes.MethodsPatients treated with CAS for symptomatic or asymptomatic carotid arterial stenosis were consecutively enrolled. Residual stenosis was estimated from post-procedure angiography findings. The effects of residual stenosis on 30-day periprocedural outcome and times to restenosis and clinical outcome were analyzed using logistic regression models and Wei-Lin-Weissfeld models, respectively.ResultsA total of 412 patients (age, 64.7 ± 17.0 years; male, 82.0%) were enrolled. The median baseline stenosis was 80% (interquartile range [IQR], 70–90%), which improved to 10% (0–30%) for residual stenosis. Residual stenosis was significantly associated with periprocedural outcome (adjusted odds ratio, 0.983; 95% confidence interval [CI], 0.965–0.999, P = 0.01) after adjustment for baseline stenosis, age, hypertension, symptomaticity, and statin use. Over the 5-year observation period, residual stenosis did not increase the global hazard for restenosis and clinical outcome (adjusted hazard ratio, 1.011; 95% CI, 0.997–1.025. In the event-specific model, residual stenosis increased the hazard for restenosis (adjusted hazard ratio, 1.041; 1.012–1.072) but not for clinical outcome (adjusted hazard ratio, 1.011; 0.997–1.025).ConclusionsResidual stenosis after carotid artery stenting may be useful to predict periprocedural outcome and restenosis.

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“…Potential subjects were excluded from the analysis if their modified Rankin Scale (mRS) scores at 3 months (primary outcome measure) were not available. About 49% (n = 131) of the study subjects had been reported in a previous publication [12].…”

Section: Selection Of Study Subjects and Data Collectionmentioning

confidence: 99%

Endovascular Treatment in Patients with Persistent Internal Carotid Artery Occlusion after Intravenous Tissue Plasminogen Activator: A Clinical Effectiveness Study

et al. 2016

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Background: There has been no large-scale trial comparing endovascular treatment (add-on EVT) after intravenous tissue plasminogen activator (IV tPA) and IV tPA alone in acute ischemic stroke (AIS) caused by internal carotid artery occlusion (ICAO). We aimed at investigating the effectiveness and safety of add-on EVT after IV tPA in AIS patients with ICAO. Methods: Between March 2010 and March 2013, 3,689 consecutive ischemic stroke patients who were hospitalized within 4.5 h of onset were identified using a prospective stroke registry at 11 centers in Korea. Among them, patients with persistent ICAO after receiving IV tPA and whose 3-month modified Rankin Scale (mRS) was available were finally enrolled. A propensity score analysis with inverse-probability of treatment weighting was used to eliminate baseline imbalances between those receiving add-on EVT and IV tPA alone. Results: Among 264 patients enrolled in this study (mean age 71.4; male 56.4%; median National Institute of Health Stroke Scale score 15), 117 (44.3%) received add-on EVT. The add-on EVT group had a higher frequency of favorable outcome on the mRS ≤2 (35.0 vs. 18.4%; adjusted OR (aOR) 2.79; 95% CI 1.66-4.67) and lower mortality (17.9 vs. 35.4%; aOR 0.24; 95% CI 0.13-0.42) at 3 months, when compared to the IV tPA-alone group. Add-on EVT did not significantly increase the risk of symptomatic hemorrhage (5.1 vs. 4.1%; aOR 1.01; 95% CI 0.37-2.70). The rate of successful recanalization (thrombolysis in cerebral infarction grade ≥2b) in the add-on EVT group was 69.2%. Conclusions: Compared to an IV tPA alone, add-on EVT can improve clinical outcomes in patients with symptomatic ICAO within 4.5 h of onset without a significant increase of symptomatic hemorrhage.

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Recanalization Therapy for Internal Carotid Artery Occlusion Presenting as Acute Ischemic Stroke

Cited by 8 publications

References 32 publications

Endovascular thrombectomy versus medical treatment for large vessel occlusion stroke with mild symptoms: A meta-analysis

Endovascular thrombectomy versus medical treatment for large vessel occlusion stroke with mild symptoms: A meta-analysis

Residual stenosis after carotid artery stenting: Effect on periprocedural and long-term outcomes

Endovascular Treatment in Patients with Persistent Internal Carotid Artery Occlusion after Intravenous Tissue Plasminogen Activator: A Clinical Effectiveness Study

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