Τίτλος:
Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Introduction One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)). Objective To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT. Methods Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated. Results A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11-20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005). Conclusions IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Συγγραφείς:
Goyal, N.
Tsivgoulis, G.
Chang, J.J.
Malhotra, K.
Goyanes, J.
Pandhi, A.
Krishnan, R.
Ishfaq, M.F.
Hoit, D.
Nickele, C.
Inoa-Acosta, V.
Katsanos, A.H.
Elijovich, L.
Alexandrov, A.
Arthur, A.S.
Περιοδικό:
Journal of Neurointerventional Surgery
Εκδότης:
BMJ Publishing Group
Λέξεις-κλειδιά:
tissue plasminogen activator, adult; aged; Alberta Stroke Program Early CT Score; Article; blood clot lysis; brain blood vessel; brain infarction; clinical outcome; controlled study; disease association; female; functional assessment; human; independence; major clinical study; male; mechanical thrombectomy; middle aged; multivariate logistic regression analysis; National Institutes of Health Stroke Scale; nuclear magnetic resonance imaging; occlusive cerebrovascular disease; prediction; preoperative care; priority journal; scoring system; x-ray computed tomography; brain infarction; cerebrovascular accident; cerebrovascular disease; diagnostic imaging; intravenous drug administration; mechanical thrombectomy; multimodality cancer therapy; predictive value; procedures; prospective study; retrospective study; thrombectomy; treatment outcome, Administration, Intravenous; Aged; Cerebral Infarction; Cerebrovascular Disorders; Combined Modality Therapy; Female; Humans; Male; Mechanical Thrombolysis; Middle Aged; Predictive Value of Tests; Prospective Studies; Retrospective Studies; Stroke; Thrombectomy; Treatment Outcome
DOI:
10.1136/neurintsurg-2019-014935
