Reperfusion Is a More Accurate Predictor of Follow-Up Infarct Volume Than Recanalization

Soares, Bruno P.; Tong, Elizabeth; Hom, Jason; Cheng, Su Chun; Bredno, Joerg; Boussel, Loîc; Smith, Wade S.; Wintermark, Max

doi:10.1161/strokeaha.109.568766

Cited by 158 publications

(130 citation statements)

References 22 publications

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“…11 Restoration of blood flow, however, which more accurately predicts response to thrombolysis, does not necessarily follow vascular recanalization. 32 Even so, we observed that smokers were more likely to reperfuse after vessel recanalization.…”

Section: February 2013mentioning

confidence: 72%

Smoking-Thrombolysis Paradox

Kufner

Nolte²,

Galinović³

et al. 2013

Stroke

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Background and Purpose— The so-called smoking-thrombolysis paradox of an improved outcome after thrombolysis was first described in smokers with myocardial infarction. We investigated whether reperfusion rates and clinical outcome differ between smokers and nonsmokers with ischemic stroke after intravenous tissue plasminogen activator. Methods— Consecutive acute ischemic stroke patients, who had magnetic resonance imaging before and 1 day after thrombolysis, were included for analysis. All of the patients received intravenous tissue plasminogen activator within 4.5 hours. Reperfusion was defined as a 75% reduction in perfusion deficit (mean transit time >6 s) after thrombolysis compared with baseline. Magnetic resonance angiography was used to evaluate arterial stenosis and occlusion. Functional outcome was assessed 3 months after stroke using the modified Rankin Score. Results— Of 148 patients, 21.6% were smokers (n=32). Smokers were younger (median, 61 years [ SD , 9.4 years] versus 75 years [ SD , 11.6 years]; P <0.001), less often women (28% versus 51%; P =0.03), had lower baseline glucose levels (median, 6.2 mmol/L [interquartile range, 5.7–6.8 mmol/L] versus 6.7 mmol/L [interquartile range, 6.1–8.2 mmol/L]; P <0.01) and higher baseline perfusion deficits (median, 53 mL [interquartile range, 13–141 mL] versus 17 mL [interquartile range, 2–66 mL]; P =0.04). In a backward stepwise regression analysis including age, sex, hypertension, glucose, perfusion deficit, and smoking, smoking had an odds ratio of 4 (95% confidence interval, 1–16; P =0.03) for reperfusion and 6 (95% confidence interval, 1–30; P =0.05) for recanalization (regression analysis for recanalization also included localization of arterial occlusion). Smokers had a better outcome (modified Rankin Score=0–2) than nonsmokers (77% versus 55%; P =0.05). Conclusions— Smoking is independently associated with recanalization and reperfusion, indicating that thrombolytic therapy acts more effectively in smokers; because of small numbers, these results should be considered preliminary. Clinical Trial Registration— URL: http://clinicaltrials.gov . Unique Identifier: NCT00715533.

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Section: February 2013mentioning

confidence: 72%

Smoking-Thrombolysis Paradox

Kufner

Nolte²,

Galinović³

et al. 2013

Stroke

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“…Prior evidence has reinforced the importance of the quality of reperfusions [22][23][24] . The quality of reperfusion was described to be a better predictor of infarct size than recanalization 25 . Therefore, the smaller the areas of perfusion defect on the final angiographic images, the smaller the size of the final infarct.…”

Section: Discussionmentioning

confidence: 99%

Not All “Successful” Angiographic Reperfusion Patients Are an Equal Validation of a Modified TICI Scoring System

et al. 2014

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Rapid reperfusion of the entire territory distal to vascular occlusions is the aim of stroke interventions. Recent studies defined successful reperfusion as establishing some perfusion with distal branch filling of <50% of territory visualized (Thrombolysis In Cerebral Infarction “TICI” 2a) or more. We investigate the importance of the quality of final reperfusion and whether a revision of the successful reperfusion definition is warranted. We retrospectively evaluated a prospective database of anterior circulation strokes treated using stentrievers to assess the quality of final reperfusion using two scores: the traditional TICI score and a modified TICI score. The modified TICI score includes an additional category (TICI 2c): near complete perfusion except for slow flow or distal emboli in a few distal cortical vessels. We compared different cut-off definitions of reperfusion (TICI 2a–3 vs. TICI-2b–3 vs. TICI 2c–3) using the area under the curve to identify their correlation with a favorable 90-day outcome (mRS≤2). In our cohort of 110 patients, 90% achieved TICI 2a-3 reperfusion with 80% achieving TICI 2b-3 and 55.5% achieving TICI 2c-3. The proportion of patients with a favorable 90-day outcome was higher in the TICI 2c (62.5%) compared to TICI 2b (44.4%) or TICI 2a (45.5%) but similar to the TICI 3 group (75.9%). A TICI 2c-3 reperfusion had a better predictive value than TICI 2b-3 for 90-day mRS 0–1. Defining successful reperfusion as TICI 2c/3 has merits. In this cohort, there was evidence toward faster recovery and better outcomes in patients with the TICI 2c vs. the traditional TICI 2b grade.

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“…If an occlusion was seen in 1 of these arterial segments on the admission CTA study, a recanalization index was calculated according to a previously reported method, 32 by using the following formula:…”

Section: Imaging Analysis Of Recanalizationmentioning

confidence: 99%

“…Volumes of abnormal MTT (MTT Ͼ 145% of the contralateral nonischemic MTT) 28 on the admission PCT sections and on the matching reperfusion PCT sections were recorded. MTT indices of reperfusion, expressed in percentages, were calculated according to a previously reported method 32 by using the following formula:…”

Section: Imaging Analysis Of Reperfusionmentioning

confidence: 99%