Comparison of the response to endovascular reperfusion in relation to site of arterial occlusion.

Neurology 2013 Aug 12;81(7):614-8. Epub 2013 Jul 12.

Stanford Stroke Center, Stanford University of Medicine, Stanford, CA, USA.

Objective: We explored the relationship between the site of vascular occlusion and the response to endovascular treatment in patients with acute ischemic stroke and also considered the impact of mismatch profile.

Methods: DEFUSE-2 was a prospective cohort study of patients treated with endovascular therapy. Patients with internal carotid artery (ICA) and middle cerebral artery (MCA) involvement were included in this substudy. Mismatch and reperfusion status was assessed on MRI. Favorable clinical response was defined as an improvement of at least 8 points on the NIH Stroke Scale.

Results: Reperfusion rates were comparable in both groups (61% for ICA and 59% for MCA). In the setting of reperfusion, percentages of favorable clinical response were similar between patients with stroke due to ICA (65%) and MCA (63%) occlusions. When reperfusion was not achieved, favorable outcomes were less frequent with obstructions of the ICA (9%) than the MCA (52%). Among target mismatch patients, the adjusted odds ratio for favorable clinical response associated with reperfusion was 39.7 (95% confidence interval 1.4-1,132.8) for ICA occlusions vs 5.1 (95% confidence interval 1.4-19.3) for MCA occlusions.

Conclusions: Endovascular reperfusion is associated with favorable clinical response regardless of the location of the arterial occlusion. This association is strongest for target mismatch patients with ICA occlusions. Target mismatch patients with either ICA or MCA occlusions appear to be good candidates for endovascular reperfusion therapy.

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0b013e3182a08f07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775690PMC
August 2013
3 Reads

Publication Analysis

Top Keywords

clinical response
16
favorable clinical
16
target mismatch
12
endovascular reperfusion
12
mismatch patients
12
confidence interval
8
arterial occlusion
8
95% confidence
8
response endovascular
8
ica mca
8
reperfusion
8
patients ica
8
ica occlusions
8
ica
7
patients
7
mca
6
response
5
mismatch
5
favorable
5
endovascular
5

Similar Publications