Vessel Patency at 24 Hours and Its Relationship With Clinical Outcomes and Infarct Volume in REVASCAT Trial (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset)

Abstract

Background and Purpose-Higher rates of target vessel patency at 24 hours were noted in the thrombectomy group compared with control group in recent randomized trials. As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as they related to clinical outcome and 24-hour infarct volume in REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset). Methods-Independent core laboratory adjudicated vessel status according to modified arterial occlusive lesion classification at 24 hours on computed tomographic/magnetic resonance (94.2%/5.8%) angiography and 24-hour infarct volume on computed tomography were studied (95/103 patients in the thrombectomy group versus 94/103 in the control group, respectively). Complete revascularization was defined as modified arterial occlusive lesion grade 3. Its effect on clinical outcome was analyzed by ordinal logistic regression. Results-Complete revascularization was achieved in 70.5% of the solitaire group and in 22.3% of the control group (P<0.001). Significant differences in complete revascularization rates were found for terminus internal carotid artery, M1, and tandem occlusions (all P<0.001) but not for M2 occlusions. In the thrombectomy group, 2 out of 63 patients (3.1%) with modified Thrombolysis in Cerebral Infarction 2b/3 after thrombectomy showed arterial reocclusion (modified arterial occlusive lesion grade 0/1) at 24 hours. Complete revascularization was associated with improved outcome in both thrombectomy (adjusted odds ratio, 4.5; 95% confidence interval, 1.9-10.9) and control groups (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-6.7). Revascularization (modified arterial occlusive lesion grade 2/3) was associated with smaller infarct volumes in either treatment arm. Conclusions-Complete revascularization at 24 hours is a powerful predictor of favorable clinical outcome, whereas revascularization of any type results in reduced infarct volume in both thrombectomy and control groups. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01692379.

Coping Strategies, Quality of Life, and Neurological Outcome in Patients Treated with Mechanical Thrombectomy after an Acute Ischemic Stroke

“…However, coping and other variables related to their adaptation to a diagnosis of stroke have not been studied [ 38 ]. In line with this, we found similar results regarding neurological outcomes and functional capacities to those obtained in the whole population studied in the REVASCAT [ 39 , 40 , 41 ], indicating that the variables analyzed in this study can be generalized to the totality of people with acute ischemic stroke currently treated with the EVT.…”

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability

“…Revascularization is a key factor in predicting good outcome [20]. Elderly patients in our study and in others ( Table 2) achieved good rates of recanalization despite the challenges of increasing atherosclerotic burden and vessel tortuosity with age [21][22][23][24][25][26].…”

The predictors and prognosis for unexpected reocclusion after mechanical thrombectomy: a meta-analysis

“…Transcranial Doppler (TCD), magnetic resonance angiography (MRA), and computed tomography angiography (CTA) were performed to determine the reocclusion within 48 hours, except in two reocclusion cases that were followed up between 1 and 180 days in one study (12). Three out of the 5 articles were retrospective studies based on a prospective cohort (8,10,12), 1 was a post-hoc analysis for a prospective cohort (9), and 1 was a retrospective observational study only (11). The publications' NOS score was ≥7, indicating high quality of these studies (15).…”

“…The definition of reocclusion is unclear in 3 articles, all of which only declares that reocclusion is detected with TCD, MRA, or CTA (8,10,11). In contrast, the other 2 articles detail the quantitative methods for identifying reocclusion (9,12). This may further produce information bias.…”

“…Despite the high incidence of successful recanalization of over 80% after MT, 3-9% of patients display reocclusion in the recanalized vessels within 24 hours after performing MT, imposing a significant impact on people's well-being and quality of life (3)(4)(5). Some previous studies have investigated the predictors and prognosis of reocclusion after MT; however, these studies yield conflicting results (3,(6)(7)(8)(9)(10)(11)(12). We aimed to summarize the existing knowledge and perform a secondary analysis to determine the predictors and prognosis of reocclusion after MT.…”