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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

Changes in median National Institute of Health Stroke Scale (NIHSS) scores before and after intraarterial thrombolysis (IAT) and at discharge according to onset-to-recanalization time. Onset-to-recanalization time was categorized as <4.5, 4.5-6, or >6 hours, or non-recanalization. *P<0.001, †P=0.021, ‡P=0.002, changes in mean NIHSS score before and after IAT in each group.
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Figure 2: Changes in median National Institute of Health Stroke Scale (NIHSS) scores before and after intraarterial thrombolysis (IAT) and at discharge according to onset-to-recanalization time. Onset-to-recanalization time was categorized as <4.5, 4.5-6, or >6 hours, or non-recanalization. *P<0.001, †P=0.021, ‡P=0.002, changes in mean NIHSS score before and after IAT in each group.

Mentions: To determine the onset-to-recanalization time interval required for a 0.5 probability of a good clinical outcome in the presence of collateral circulation, patients were classified according to onset-to-recanalization times of <4.5, 4.5-6, or >6 hours, or non-recanalization after IAT. Although the mean initial NIHSS score was similar among groups, improvements in the NIHSS score after IAT differed significantly. Patients recanalized within 4.5 or 6 hours (both P<0.001) had significantly lower mean NIHSS scores after IAT and at discharge than patients recanalized after >6 hours (P=0.021) or those who did not undergo recanalization (P=0.002) (Figure 2).


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)

Changes in median National Institute of Health Stroke Scale (NIHSS) scores before and after intraarterial thrombolysis (IAT) and at discharge according to onset-to-recanalization time. Onset-to-recanalization time was categorized as <4.5, 4.5-6, or >6 hours, or non-recanalization. *P<0.001, †P=0.021, ‡P=0.002, changes in mean NIHSS score before and after IAT in each group.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Changes in median National Institute of Health Stroke Scale (NIHSS) scores before and after intraarterial thrombolysis (IAT) and at discharge according to onset-to-recanalization time. Onset-to-recanalization time was categorized as <4.5, 4.5-6, or >6 hours, or non-recanalization. *P<0.001, †P=0.021, ‡P=0.002, changes in mean NIHSS score before and after IAT in each group.
Mentions: To determine the onset-to-recanalization time interval required for a 0.5 probability of a good clinical outcome in the presence of collateral circulation, patients were classified according to onset-to-recanalization times of <4.5, 4.5-6, or >6 hours, or non-recanalization after IAT. Although the mean initial NIHSS score was similar among groups, improvements in the NIHSS score after IAT differed significantly. Patients recanalized within 4.5 or 6 hours (both P<0.001) had significantly lower mean NIHSS scores after IAT and at discharge than patients recanalized after >6 hours (P=0.021) or those who did not undergo recanalization (P=0.002) (Figure 2).

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