Korean Journal of Radiology

  • 제21권5호
  • /
  • Pages.582-587
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  • 2020
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Predictors of Good Outcomes in Patients with Failed Endovascular Thrombectomy

  • Hyungjong Park (Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Byung Moon Kim (Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Jang-Hyun Baek (Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jun-Hwee Kim (Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Ji Hoe Heo (Department of Neurology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Dong Joon Kim (Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Hyo Suk Nam (Department of Neurology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Young Dae Kim (Department of Neurology, Severance Hospital Stroke Center, Yonsei University College of Medicine)
  • 투고 : 2019.08.06
  • 심사 : 2020.01.02
  • 발행 : 2020.05.01
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초록

Objective: Endovascular thrombectomy (EVT) fails in approximately 20% of anterior circulation large vessel occlusion (AC-LVO). Nonetheless, the factors that affect clinical outcomes of non-recanalized AC-LVO despite EVT are less studied. The purpose of this study was to identify the factors affecting clinical outcomes in non-recanalized AC-LVO patients despite EVT. Materials and Methods: This was a retrospective analysis of clinical and imaging data from 136 consecutive patients who demonstrated recanalization failure (modified thrombolysis in cerebral ischemia [mTICI], 0-2a) despite EVT for AC-LVO. Data were collected in prospectively maintained registries at 16 stroke centers. Collateral status was categorized into good or poor based on the CT angiogram, and the mTICI was categorized as 0-1 or 2a on the final angiogram. Patients with good (modified Rankin Scale [mRS], 0-2) and poor outcomes (mRS, 3-6) were compared in multivariate analysis to evaluate the factors associated with a good outcome. Results: Thirty-five patients (25.7%) had good outcomes. The good outcome group was younger (odds ratio [OR], 0.962; 95% confidence interval [CI], 0.932-0.992; p = 0.015), had a lower incidence of hypertension (OR, 0.380; 95% CI, 0.173-0.839; p = 0.017) and distal internal carotid artery involvement (OR, 0.149; 95% CI, 0.043-0.520; p = 0.003), lower initial National Institute of Health Stroke Scale (NIHSS) (OR, 0.789; 95% CI, 0.713-0.873; p < 0.001) and good collateral status (OR, 13.818; 95% CI, 3.971-48.090; p < 0.001). In multivariate analysis, the initial NIHSS (OR, 0.760; 95% CI, 0.638-0.905; p = 0.002), good collateral status (OR, 14.130; 95% CI, 2.264-88.212; p = 0.005) and mTICI 2a recanalization (OR, 5.636; 95% CI, 1.216-26.119; p = 0.027) remained as independent factors with good outcome in non-recanalized patients. Conclusion: Baseline NIHSS score, good collateral status, and mTICI 2a recanalization remained independently associated with clinical outcome in non-recanalized patients. mTICI 2a recanalization would benefit patients with good collaterals in non-recanalized AC-LVO patients despite EVT.

키워드

과제정보

This work supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HC15C1056).

참고문헌

  1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018;49:e46-e99 
  2. Hong KS, Ko SB, Yu KH, Jung C, Park SQ, Kim BM, et al. Update of the Korean clinical practice guidelines for endovascular recanalization therapy in patients with acute ischemic stroke. J Stroke 2016;18:102-113 
  3. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708-718 
  4. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11-21 
  5. Costalat V, Lobotesis K, Machi P, Mourand I, Maldonado I, Heroum C, et al. Prognostic factors related to clinical outcome following thrombectomy in ischemic stroke (RECOST study). 50 Patients prospective study. Eur J Radiol 2012;81:4075-4082 
  6. Soize S, Barbe C, Kadziolka K, Estrade L, Serre I, Pierot L. Predictive factors of outcome and hemorrhage after acute ischemic stroke treated by mechanical thrombectomy with a stent-retriever. Neuroradiology 2013;55:977-987 
  7. Daou B, Chalouhi N, Starke RM, Dalyai R, Hentschel K, Jabbour P, et al. Predictors of outcome, complications, and recanalization of the solitaire device: a study of 89 cases. Neurosurgery 2015;77:355-361 
  8. Ozdemir O, Giray S, Arlier Z, Bas, DF, Inanc Y, Colak E. Predictors of a good outcome after endovascular stroke treatment with stent retrievers. ScientificWorldJournal 2015;2015:403726 
  9. Yoon W, Kim SK, Park MS, Baek BH, Lee YY. Predictive factors for good outcome and mortality after stent-retriever thrombectomy in patients with acute anterior circulation stroke. J Stroke 2017;19:97-103 
  10. Kim BM, Baek JH, Heo JH, Nam HS, Kim YD, Yoo J, et al. Collateral status affects the onset-to-reperfusion time window for good outcome. J Neurol Neurosurg Psychiatry 2018;89:903-909 
  11. Menon BK, d'Esterre CD, Qazi EM, Almekhlafi M, Hahn L, Demchuk AM, et al. Multiphase CT angiography: a new tool for the imaging triage of patients with acute ischemic stroke. Radiology 2015;275:510-520 
  12. Lemeshow S, Hosmer DW Jr. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 1982;115:92-106 
  13. Bang OY, Saver JL, Kim SJ, Kim GM, Chung CS, Ovbiagele B, et al. Collateral flow predicts response to endovascular therapy for acute ischemic stroke. Stroke 2011;42:693-699 
  14. Menon BK, Smith EE, Modi J, Patel SK, Bhatia R, Watson TW, et al. Regional leptomeningeal score on CT angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions. AJNR Am J Neuroradiol 2011;32:1640-1645 
  15. Maas MB, Lev MH, Ay H, Singhal AB, Greer DM, Smith WS, et al. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke 2009;40:3001-3005 
  16. Miteff F, Levi CR, Bateman GA, Spratt N, McElduff P, Parsons MW. The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke. Brain 2009;132:2231-2238 
  17. Nambiar V, Sohn SI, Almekhlafi MA, Chang HW, Mishra S, Qazi E, et al. CTA collateral status and response to recanalization in patients with acute ischemic stroke. AJNR Am J Neuroradiol 2014;35:884-890 
  18. Hwang YH, Kang DH, Kim YW, Kim YS, Park SP, Liebeskind DS. Impact of time-to-reperfusion on outcome in patients with poor collaterals. AJNR Am J Neuroradiol 2015;36:495-500 
  19. Lansberg MG, Christensen S, Kemp S, Mlynash M, Mishra N, Federau C, et al. Computed tomographic perfusion to predict response to recanalization in ischemic stroke. Ann Neurol 2017;81:849-856 
  20. Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998;55:1475-1482 
  21. Castonguay AC, Zaidat OO, Novakovic R, Nguyen TN, Taqi MA, Gupta R, et al. Influence of age on clinical and revascularization outcomes in the North American solitaire stent-retriever acute stroke registry. Stroke 2014;45:3631-3636 
  22. Tisserand M, Seners P, Turc G, Legrand L, Labeyrie MA, Charron S, et al. Mechanisms of unexplained neurological deterioration after intravenous thrombolysis. Stroke 2014;45:3527-3534 
  23. Shi ZS, Liebeskind DS, Xiang B, Ge SG, Feng L, Albers GW, et al. Predictors of functional dependence despite successful revascularization in large-vessel occlusion strokes. Stroke 2014;45:1977-1984 
  24. Di Maria F, Mazighi M, Kyheng M, Labreuche J, Rodesch G, Consoli A, et al. Intravenous thrombolysis prior to mechanical thrombectomy in acute ischemic stroke: silver bullet or useless bystander? J Stroke 2018;20:385-393 
  25. Broeg-Morvay A, Mordasini P, Bernasconi C, Buhlmann M, Pult F, Arnold M, et al. Direct mechanical intervention versus combined intravenous and mechanical intervention in large artery anterior circulation stroke: a matched-pairs analysis. Stroke 2016;47:1037-1044 
  26. Desilles JP, Loyau S, Syvannarath V, Gonzalez-Valcarcel J, Cantier M, Louedec L, et al. Alteplase reduces downstream microvascular thrombosis and improves the benefit of large artery recanalization in stroke. Stroke 2015;46:3241-3248 
  27. Lee JS, Hong KS. Endovascular therapy: the second round begins. J Stroke 2017;19:119-120