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Impacts of rapid recanalization and collateral circulation on clinical outcome after intraarterial thrombolysis.

Jeong HS, Kwon HJ, Song HJ, Koh HS, Kim YS, Lee JH, Shin JE, Lee SH, Kim J - J Stroke (2015)

Bottom Line: Changes in National Institute of Health Stroke Scale (NHISS) score before and after IAT and modified Rankins scale scores 3 months after discharge were compared with respect to onset-to-recanalization time.Outcome analyses according to onset-to-recanalization time showed patients recanalized <6 hours had lower NHISS scores (<4.5, 4.5-6, >6 hours of onset-to-recanalization time, and non-recanalization: 5.1, 6.9, 11.9, and 19.8, respectively) at discharge and higher percentages of good clinical outcome (69%, 66.7%, 21.9%, and 0%, respectively) 3 months after IAT.The time window to expect a high probability of a good clinical outcome after IAT is highly dependent on the collateral circulation.

View Article: PubMed Central - PubMed

Affiliation: Regional Cerebrovascular Center, Hospital and School of Medicine, chungnam National University, Daejeon, Korea. ; Department of Neurology, Hospital and School of Medicine, Daejeon, Korea.

ABSTRACT

Background and purpose: Rapid recanalization might improve clinical outcomes after intraarterial thrombolysis (IAT) for acute ischemic stroke patients with collateral circulation. We determined whether rapid recanalization and collateral circulation affect clinical outcomes after IAT.

Methods: We retrospectively evaluated the clinical and radiological data of 134 consecutive patients who underwent IAT for intracranial artery occlusion. The interval from symptom onset to recanalization after IAT (onset-to-recanalization time) as an estimate of the probability of good clinical outcome (modified Rankin scale 0-2) was calculated in patients with collateral circulation in the ischemic hemisphere, which was rated poor (0/1 American Society of Interventional and Therapeutic Neuroradiology criteria) or good (2-4). Changes in National Institute of Health Stroke Scale (NHISS) score before and after IAT and modified Rankins scale scores 3 months after discharge were compared with respect to onset-to-recanalization time.

Results: In patients with good collateral circulation, the estimated onset-to-recanalization time for a 0.5 probability of a good clinical outcome was 347 minutes; with poor collateral circulation, it was 172 minutes for a 0.2 probability of good clinical outcome. Outcome analyses according to onset-to-recanalization time showed patients recanalized <6 hours had lower NHISS scores (<4.5, 4.5-6, >6 hours of onset-to-recanalization time, and non-recanalization: 5.1, 6.9, 11.9, and 19.8, respectively) at discharge and higher percentages of good clinical outcome (69%, 66.7%, 21.9%, and 0%, respectively) 3 months after IAT.

Conclusions: The time window to expect a high probability of a good clinical outcome after IAT is highly dependent on the collateral circulation.

No MeSH data available.


Related in: MedlinePlus

Estimated and lower bounds of onset-to-recanalization times with respect to the probability of a good clinical outcome according to (A) good and (B) poor collateral circulation status before intraarterial thrombolysis in successfully recanalized patients. Estimated, estimated onset-to-recanalization time for a specified probability of a good clinical outcome; lower bound, lower bound of the onset-to-recanalization time for specified probability of a good clinical outcome with 95% and 70% confidence intervals in patients with good and poor collateral circulation, respectively.
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Figure 1: Estimated and lower bounds of onset-to-recanalization times with respect to the probability of a good clinical outcome according to (A) good and (B) poor collateral circulation status before intraarterial thrombolysis in successfully recanalized patients. Estimated, estimated onset-to-recanalization time for a specified probability of a good clinical outcome; lower bound, lower bound of the onset-to-recanalization time for specified probability of a good clinical outcome with 95% and 70% confidence intervals in patients with good and poor collateral circulation, respectively.

Mentions: The impact of collateral circulation on the relationship between onset-to-recanalization time and good clinical outcome is shown in Figure 1 and Supplementary Table I. In patients with good collateral circulation before IAT, the estimated onset-to-recanalization time for a 0.5 probability of a good clinical outcome was 347 minutes. The maximum onset-to-recanalization time to expect a 0.5 probability of a good clinical outcome (i.e., the lower bound of the 95% one-sided CIs of the probability) was 275 minutes. In patients with poor collateral circulation, the expected and maximum onset-to-recanalization times were dramatically shorter: that for a 0.2 probability of a good clinical outcome was 172 minutes. The maximum onset-to-recanalization time was 31 minutes if the confidence limit was lowered to 70%.


Impacts of rapid recanalization and collateral circulation on clinical outcome after intraarterial thrombolysis.

Jeong HS, Kwon HJ, Song HJ, Koh HS, Kim YS, Lee JH, Shin JE, Lee SH, Kim J - J Stroke (2015)

Estimated and lower bounds of onset-to-recanalization times with respect to the probability of a good clinical outcome according to (A) good and (B) poor collateral circulation status before intraarterial thrombolysis in successfully recanalized patients. Estimated, estimated onset-to-recanalization time for a specified probability of a good clinical outcome; lower bound, lower bound of the onset-to-recanalization time for specified probability of a good clinical outcome with 95% and 70% confidence intervals in patients with good and poor collateral circulation, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325642&req=5

Figure 1: Estimated and lower bounds of onset-to-recanalization times with respect to the probability of a good clinical outcome according to (A) good and (B) poor collateral circulation status before intraarterial thrombolysis in successfully recanalized patients. Estimated, estimated onset-to-recanalization time for a specified probability of a good clinical outcome; lower bound, lower bound of the onset-to-recanalization time for specified probability of a good clinical outcome with 95% and 70% confidence intervals in patients with good and poor collateral circulation, respectively.
Mentions: The impact of collateral circulation on the relationship between onset-to-recanalization time and good clinical outcome is shown in Figure 1 and Supplementary Table I. In patients with good collateral circulation before IAT, the estimated onset-to-recanalization time for a 0.5 probability of a good clinical outcome was 347 minutes. The maximum onset-to-recanalization time to expect a 0.5 probability of a good clinical outcome (i.e., the lower bound of the 95% one-sided CIs of the probability) was 275 minutes. In patients with poor collateral circulation, the expected and maximum onset-to-recanalization times were dramatically shorter: that for a 0.2 probability of a good clinical outcome was 172 minutes. The maximum onset-to-recanalization time was 31 minutes if the confidence limit was lowered to 70%.

Bottom Line: Changes in National Institute of Health Stroke Scale (NHISS) score before and after IAT and modified Rankins scale scores 3 months after discharge were compared with respect to onset-to-recanalization time.Outcome analyses according to onset-to-recanalization time showed patients recanalized <6 hours had lower NHISS scores (<4.5, 4.5-6, >6 hours of onset-to-recanalization time, and non-recanalization: 5.1, 6.9, 11.9, and 19.8, respectively) at discharge and higher percentages of good clinical outcome (69%, 66.7%, 21.9%, and 0%, respectively) 3 months after IAT.The time window to expect a high probability of a good clinical outcome after IAT is highly dependent on the collateral circulation.

View Article: PubMed Central - PubMed

Affiliation: Regional Cerebrovascular Center, Hospital and School of Medicine, chungnam National University, Daejeon, Korea. ; Department of Neurology, Hospital and School of Medicine, Daejeon, Korea.

ABSTRACT

Background and purpose: Rapid recanalization might improve clinical outcomes after intraarterial thrombolysis (IAT) for acute ischemic stroke patients with collateral circulation. We determined whether rapid recanalization and collateral circulation affect clinical outcomes after IAT.

Methods: We retrospectively evaluated the clinical and radiological data of 134 consecutive patients who underwent IAT for intracranial artery occlusion. The interval from symptom onset to recanalization after IAT (onset-to-recanalization time) as an estimate of the probability of good clinical outcome (modified Rankin scale 0-2) was calculated in patients with collateral circulation in the ischemic hemisphere, which was rated poor (0/1 American Society of Interventional and Therapeutic Neuroradiology criteria) or good (2-4). Changes in National Institute of Health Stroke Scale (NHISS) score before and after IAT and modified Rankins scale scores 3 months after discharge were compared with respect to onset-to-recanalization time.

Results: In patients with good collateral circulation, the estimated onset-to-recanalization time for a 0.5 probability of a good clinical outcome was 347 minutes; with poor collateral circulation, it was 172 minutes for a 0.2 probability of good clinical outcome. Outcome analyses according to onset-to-recanalization time showed patients recanalized <6 hours had lower NHISS scores (<4.5, 4.5-6, >6 hours of onset-to-recanalization time, and non-recanalization: 5.1, 6.9, 11.9, and 19.8, respectively) at discharge and higher percentages of good clinical outcome (69%, 66.7%, 21.9%, and 0%, respectively) 3 months after IAT.

Conclusions: The time window to expect a high probability of a good clinical outcome after IAT is highly dependent on the collateral circulation.

No MeSH data available.


Related in: MedlinePlus