Recanalization and Angiographic Reperfusion Are Both Associated with a Favorable Clinical Outcome in the IMS III Trial

Background: Prompt revascularization is the main goal of acute ischemic stroke treatment. We examined which revascularization scale - reperfusion (modified Treatment in Cerebral Infarctions, mTICI) or recanalization (Arterial Occlusive Lesion, AOL) - better predicted the clinical outcome in ischemic stroke participants treated with endovascular therapy (EVT). Additionally, we determined the optimal thresholds for the predictive accuracy of each scale. Methods: We included participants from the Interventional Management of Stroke (IMS) III trial with complete occlusion in the internal carotid artery terminus or proximal middle cerebral artery (M1 or M2) who completed EVT within 7 h of symptom onset. The abilities of the AOL and mTICI scales to predict a favorable outcome (defined as a modified Rankin Scale score of 0-2 at 3 months) were compared by receiver operating characteristic analyses. The maximal sensitivity and specificity for each revascularization scale were established. Results: Among 240 participants who met the study inclusion criteria, 79 (33%) achieved a favorable outcome. Higher scores of mTICI and AOL increased the likelihood of a favorable outcome (2.7% with mTICI 0 vs. 83.3% with mTICI 3, and 3.0% with AOL 0 vs. 43% with AOL 3). The accuracy of mTICI reperfusion and AOL recanalization for a favorable outcome prediction was similar, with optimal thresholds of mTICI 2b/3 and AOL 3, respectively. Conclusion: Reperfusion (mTICI) and recanalization (AOL) predicted a favorable clinical outcome with comparable accuracy in ischemic stroke participants treated with EVT. Optimal revascularization goals to maximize clinical outcome (modified Rankin Scale score of 0-2) consisted of complete recanalization (AOL 3) and reperfusion of at least 50% of the arterial tree of the symptomatic artery (mTICI 2b/3) in the IMS III trial setting.

Download Full-text

Abstract 268: Is There a Weekend Effect on Telestroke Code Time Metrics?

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.268 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Ganesh Asaithambi ◽

Amy L Castle ◽

Emily H Marino ◽

Bridget M Ho ◽

Sandra K Hanson

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Scale Score ◽

Mortality Rates ◽

Weekend Effect ◽

Favorable Outcome ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Code Process

Background: It has been suggested that there is a “weekend effect” resulting in higher mortality rates for stroke patients admitted on weekends. We examine this phenomenon for acute ischemic stroke (AIS) patients presenting to telestroke (TS) sites to determine its effect on stroke code process times and outcomes. Methods: From October 2015-June 2017, we reviewed consecutive AIS patients receiving IV alteplase within our TS network who then were transferred to our CSC. We compared patients presenting to TS sites on weekdays (Monday 0700 to Friday 1859) to patients presenting on weekends (Friday 1900 to Monday 0659). We analyzed door to code activation, code activation to TS evaluation, door to imaging, and door to needle times. Rates of favorable outcome (modified Rankin Scale score ≤2) and death at 90 days were compared. Results: We identified 89 (54 weekday, 35 weekend) patients (mean age 71.8±13.3 years, 47.2% women) during the study period. Median door to code activation (15 [5, 27] vs 8 [1, 17] mins, p=0.01) and door to needle (61 [49, 73] vs 47 [35, 59] mins, p=0.003) times were significantly longer for patients presenting on weekends compared to weekdays. There were no significant differences in median door to imaging (weekend 17 [7, 30] vs weekday 11 [6, 21], p=0.1) and code activation to TS evaluation (weekend 7 [6, 10] vs weekday 5 [4, 9], p=0.14) times. The rates of favorable outcome (weekend 50% vs weekday 66.7%, p=0.18) and death (weekend 8.3% vs weekday 4.8%, p=0.56) at 90 days were not significantly different. Conclusion: While there were no significant differences in outcomes, the “weekend effect” results in slower door to code activation and door to needle times. Efforts to improve methods in increasing efficiency of care on weekends should be considered.

Download Full-text

Weekday Versus Weekend Presentation in the Acute Management of Ischemic Stroke Through Telemedicine

The Neurohospitalist ◽

10.1177/1941874419878020 ◽

2019 ◽

Vol 10 (2) ◽

pp. 115-117

Author(s):

Ganesh Asaithambi ◽

Amy L. Castle ◽

Megan E. Tipps ◽

Bridget M. Ho ◽

Emily H. Marino ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Scale Score ◽

Mortality Rates ◽

Weekend Effect ◽

Favorable Outcome ◽

Acute Management ◽

Modified Rankin Scale ◽

Intravenous Alteplase

A “weekend effect” resulting in higher mortality rates for patients with stroke admitted on weekends has been reported. We examine this phenomenon for patients with acute ischemic stroke (AIS) presenting to telestroke (TS) sites to determine its effect on stroke alert process times and outcomes. From October 2015 to June 2017, we reviewed patients with AIS receiving intravenous alteplase within our TS network. We compared patients presenting to TS sites on weekdays (Monday 07:00 to Friday 18:59) to those presenting on weekends (Friday 19:00 to Monday 06:59). We analyzed door-to-alert activation, alert activation-to-TS evaluation, door-to-imaging, and door-to-needle times. Rates of favorable outcome (modified Rankin Scale score ≤2) and death at 90 days were compared. We identified 89 (54 weekday and 35 weekend) patients (mean age: 71.8 ± 13.3 years, 47.2% women) during the study period. Median door-to-alert activation ( P = .01) and door-to-needle ( P = .004) times were significantly longer for patients presenting on weekends compared to weekdays. There were no significant differences in median door-to-imaging ( P = .1) and alert activation-to-TS evaluation ( P = .07) times. Rates of favorable outcome ( P = .19) and death ( P = .56) at 90 days did not differ. While there were no significant differences in outcomes, patients presenting on weekends had longer door-to-alert activation and door-to-needle times. Efforts to improve methods in efficiency of care on weekends should be considered.

Download Full-text

Incomplete Large Vessel Occlusions in Mechanical Thrombectomy: An Independent Predictor of Favorable Outcome in Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000477499 ◽

2017 ◽

Vol 44 (3-4) ◽

pp. 113-121 ◽

Cited By ~ 6

Author(s):

Volker Maus ◽

Seunghwa You ◽

Alev Kalkan ◽

Jan Borggrefe ◽

Christoph Kabbasch ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Mechanical Thrombectomy ◽

National Institutes Of Health ◽

Large Vessel ◽

Favorable Outcome ◽

Vessel Occlusion ◽

All Cause Mortality ◽

Secondary Endpoints ◽

Favorable Clinical Outcome

Background and Purpose: Cerebral large vessel occlusion (LVO) in acute ischemic stroke (AIS) may be complete (CLVO) or incomplete (ILVO). The influence of ILVO on clinical outcome after mechanical thrombectomy (MT) remains unclear. We investigated primarily the clinical outcome in patients with AIS due to ILVO or CLVO. Methods: Five hundred three consecutive AIS patients with LVO treated with stent-retriever or direct aspiration-based MT between 2010 and 2016 were analyzed. The primary endpoint was favorable clinical outcome (modified Rankin Scale ≤2) at 90 days; secondary endpoints were periprocedural parameters. Results: Forty-nine patients (11.3%) with a median National Institutes of Health Stroke Scale (NIHSS) of 11 presented with ILVO and the remainder presented with CLVO and median NIHSS of 15 (p < 0.001). The median groin puncture-to-reperfusion time was 30 vs. 67 min, respectively (p < 0.001). Successful reperfusion was reached in 47 out of 49 ILVO (95.9%) vs. 298 out of 381 CLVO (78.2%; p < 0.005) with less retrieval maneuvers (1.7 ± 2.2 vs. 3.0 ± 2.5; p < 0.001). The favorable outcome at 90 days was 81% in patients with ILVO vs. 29.1% in CLVO (p < 0.001); respective all-cause mortality rates were 6.4 vs. 28.5% (p < 0.001). Periprocedural complications (6.9%) occurred exclusively in CLVO patients (p < 0.05). ILVO was associated with favorable clinical outcome independent of age and NIHSS in multivariate logistic regression both in the anterior (OR 3.6; 95% CI 1.8-6.9; p < 0.001) and posterior circulation (OR 3.5; 95% CI 1.8-6.9; p < 0.001). Conclusions: AIS due to ILVO is frequent and is associated with a nearly threefold higher chance of favorable clinical outcome at 90 days, independent of age and initial NIHSS compared to CLVO.

Download Full-text

Predictors of Outcome, Complications, and Recanalization of the Solitaire Device

Neurosurgery ◽

10.1227/neu.0000000000000830 ◽

2015 ◽

Vol 77 (3) ◽

pp. 355-361 ◽

Cited By ~ 12

Author(s):

Badih Daou ◽

Nohra Chalouhi ◽

Robert M. Starke ◽

Richard Dalyai ◽

Kate Hentschel ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Infarction ◽

Acute Ischemic Stroke ◽

Scale Score ◽

Univariate Analysis ◽

Favorable Outcome ◽

Modified Rankin Scale ◽

Nihss Score ◽

Flow Restoration ◽

The Mean

Abstract BACKGROUND: The use of mechanical thrombectomy in the management of acute ischemic stroke is becoming increasingly popular. OBJECTIVE: To identify notable factors that affect outcome, revascularization, and complications in patients with acute ischemic stroke treated with the Solitaire Flow Restoration Revascularization device. METHODS: Eighty-nine patients treated with the Solitaire Flow Restoration Revascularization device (ev3/Covidien Vascular Therapies, Irvine, California) were retrospectively analyzed. Three endpoints were considered: revascularization (Thrombolysis In Cerebral Infarction), outcome (modified Rankin Scale score), and complications. Univariate analysis and multivariate logistic regression were conducted to determine significant predictors. RESULTS: The mean time from onset of symptoms to the start of intervention was 6.7 hours. The average procedure length was 58 minutes. The mean NIH Stroke Scale (NIHSS) score was 16 on arrival and 8 at discharge. Of the patients, 6.7% had a symptomatic intracerebral hemorrhage, 16.8% had fatal outcomes within 3 months post-intervention, and 81.4% had a successful recanalization. Thrombus location in the M1 segment of the middle cerebral artery was associated with successful recanalization (thrombolysis in cerebral infarction 2b/3) (P = .003). Of the patients, 56.6% had a favorable outcome (modified Rankin Scale score at 3 months: 0–2). In patients younger than 80 years of age, 66.7% had favorable outcome. Increasing age (P = .01) and NIHSS score (P = .002) were significant predictors of a poor outcome. On multivariate analysis, NIHSS score on admission (P = .05) was a predictor of complications. On univariate analysis, increasing NIHSS score from admission to 24 hours after the procedure (P = .05) and then to discharge (P = .04) was a predictor of complications. Thrombus location in the posterior circulation (P = .04) and increasing NIHSS score (P = .04) predicted mortality. CONCLUSION: The Solitaire device is safe and effective in achieving successful recanalization after acute ischemic stroke. Important factors to consider include age, NIHSS score, and location.

Download Full-text

Abstract T P12: Pretreatment With IV tPA Does Not Impact Outcome in Patients Undergoing Endovascular Stroke Treatment

Stroke ◽

10.1161/str.45.suppl_1.tp12 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Kavit B Shah ◽

Anne C Tita ◽

Syed F Zaidi ◽

Mouhammad A Jumaa

Keyword(s):

Clinical Outcome ◽

Randomized Trials ◽

Favorable Outcome ◽

Stroke Treatment ◽

Hemorrhagic Complications ◽

Group Rate ◽

Baseline Characteristics ◽

Favorable Clinical Outcome ◽

Iv Tpa ◽

Impact Outcome

Objective: We sought to compare the clinical outcomes of patients who underwent Intra-arterial Treatment (IAT) IAT with or without IV tPA pretreatment at our center. METHODS: We reviewed records of AIS patients who underwent IAT at our center from July 2012 - Jul 2013. The following data were collected and analyzed: patients’ demographics, baseline characteristics, treatment times and methods, rate of symptomatic and asymptomatic intracerebral hemorrhage, and favorable clinical outcome defined as modified Rankin score (mRS) ≤ 2 at 90 days or at last observation for patients treated within the last 89 days RESULTS: Seventy consecutive patients who underwent IAT were identified. Overall 33 (47.1%) patients had favorable outcome. There were 15/70 (21.4%) asymptomatic and 2/70 (2.8%) symptomatic hemorrhages following IAT. Pretreatment with IV tPA 32/70 (45.7%) had no significant impact on the rate of asymptomatic (6/32, 18.7% versus 9/38, 23.6%) or symptomatic (1/32, 0.03% versus 1/38, 0.03%) ICH, p=0.8. There were no instances of retroperitoneal or groin hemorrhagic complications in either group. Rate of recanalization was comparable between the IV tPA (26/32, 81.2%) and non-IV tPA groups (32/38, 84.2%).Also the rate of favorable outcome was comparable between the IV tPA pretreatment (15/32, 46.8%) and non-IV tPA (18/38, 47.3%) groups. In a multivariate analysis, young age was the only predictor of favorable clinical outcome in this cohort (OR: 0.93; 95%CI: 0.88-0.99; p=0.03). CONCLUSION: Our results suggest that IV tPA pretreatment has no impact on eventual patient outcome following endovascular stroke treatment. This finding may be helpful in designing future randomized trials.

Download Full-text

Abstract WP17: Association of Blood Glucose and Clinical Outcome After Mechanical Thrombectomy for Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.wp17 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Weston R Gordon ◽

Anit Behera ◽

John Chibnall ◽

Amer Alshekhlee ◽

Richard C Callison ◽

...

Keyword(s):

Ischemic Stroke ◽

Blood Glucose ◽

Clinical Outcome ◽

Hospital Stay ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Univariate Analysis ◽

Favorable Outcome ◽

Favorable Clinical Outcome ◽

Serial Measurements

Background: Elevated blood glucose (BG) levels at admission following acute ischemic stroke (AIS) have been associated with adverse clinical outcomes in thrombolytic and non-thrombolytic treated patients. This association has been inconsistent and has not been studied after mechanical thrombectomy (MT). The current study looks at multiple BG parameters and their association with outcome following MT in AIS. Methods: AIS patients undergoing MT with a retrievable stent between 2012 and 2016 at two stroke centers were studied. Favorable clinical outcome was defined as having a modified Rankin Scale score (mRS) of 0-2 at three months. Admission BG, maximum BG during the hospital stay, and serial measurements every 4-6 hours in the first 24 hours were recorded. The following demographic and clinical data was also collected: age, sex, baseline NIHSS score, onset-to-reperfusion times, HgA1c, and stroke mechanism. Results: Seventy-nine patients were identified (mean age 69, 49% male, SEM= 1.56); thirty-three patients had a favorable clinical outcome at three months and 46 had unfavorable outcomes. In univariate analysis, BG variability (standard deviation of BG, SD) in the first 24 hours following admission and maximum BG during hospital stay was associated with unfavorable outcomes (Table 1). The association between admission BG and favorable outcome was not statistically significant. In multivariate logistic regression analysis the SD of BG (OR= 1.08, 95% CI= 1.02-1.13, P= .005) had the highest predictive value for favorable outcome. Conclusions: Greater BG variability is associated with worse clinical outcome in patients with AIS undergoing MT. Using SD and/or serial measurements of BG appear better than single BG measurements at predicting clinical outcome in this population.

Download Full-text

Evidence that Tenecteplase Is Noninferior to Alteplase for Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.119.025080 ◽

2019 ◽

Vol 50 (8) ◽

pp. 2156-2162 ◽

Cited By ~ 19

Author(s):

Adrian M. Burgos ◽

Jeffrey L. Saver

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Scale Score ◽

Meta Analysis ◽

Functional Independence ◽

Risk Difference ◽

Guideline Recommendation ◽

Modified Rankin Scale ◽

End Points ◽

Stroke Treatment

Background and Purpose— TNK (tenecteplase), a newer fibrinolytic agent, has practical delivery advantages over ALT (alteplase) that would make it a useful agent if noninferior in acute ischemic stroke treatment outcome. Accordingly, the most recent US American Heart Association/American Stroke Association acute ischemic stroke guideline recognized TNK as an alternative to ALT, but only based on informal consideration, rather than formal meta-analysis, of completed randomized control trials. Methods— Systematic literature search and formal meta-analysis were conducted per PRISMA guidelines (Preferred Reporting Items for Systemic Reviews and Meta-Analyses), adapted to noninferiority analysis. The primary outcome of freedom from disability (modified Rankin Scale score, 0–1) outcome at 3 m, and additional efficacy and safety outcomes, were analyzed. Results— Systematic search identified 5 trials enrolling 1585 patients (828 TNK, 757 ALT). Across all trials, mean age was 70.8, 58.5% male, baseline National Institutes of Health Stroke Scale mean 7.0, and time from last known well to treatment start mean 148 minutes. All ALT patients received standard 0.9 mg/kg dosing, while TNK dosing was 0.1 mg/kg in 6.8%, 0.25 mg/kg in 24.6%, and 0.4 mg/kg in 68.6%. For the primary end point, crude cumulative rates of disability-free (modified Rankin Scale score, 0–1) 3 m outcome were TNK 57.9% versus ALT 55.4%. Informal, random-effects meta-analysis, the risk difference was 4% (95% CI, −1% to 8%). The lower 95% CI bound fell well within the prespecified noninferiority margin. Similar results were seen for the additional efficacy end points: functional independence (modified Rankin Scale score, 0–2): crude TNK 71.9% versus ALT 70.5%, risk difference 2% (95% CI, −3% to 6%); and modified Rankin Scale shift analysis, common odds ratio 1.21 (95% CI, 0.93–1.57). For safety end points, lower event rates reduced power, but point estimates were also consistent with noninferiority Conclusions— Accumulated clinical trial data provides strong evidence that TNK is noninferior to ALT in the treatment of acute ischemic stroke. These findings provide formal support for the recent guideline recommendation to consider TNK an alternative to ALT.

Download Full-text

Hemodynamic Status During Endovascular Stroke Treatment: Association of Blood Pressure with Functional Outcome

Neurocritical Care ◽

10.1007/s12028-021-01229-w ◽

2021 ◽

Author(s):

Min Chen ◽

Dorothea Kronsteiner ◽

Johannes Pfaff ◽

Simon Schieber ◽

Laura Jäger ◽

...

Keyword(s):

Blood Pressure ◽

Standard Deviation ◽

Functional Outcome ◽

Scale Score ◽

Endovascular Therapy ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Vessel Occlusion ◽

Stroke Treatment ◽

The Mean

Abstract Background Optimal blood pressure (BP) management during endovascular stroke treatment in patients with large-vessel occlusion is not well established. We aimed to investigate associations of BP during different phases of endovascular therapy with reperfusion and functional outcome. Methods We performed a post hoc analysis of a single-center prospective study that evaluated a new simplified procedural sedation standard during endovascular therapy (Keep Evaluating Protocol Simplification in Managing Periinterventional Light Sedation for Endovascular Stroke Treatment). BP during endovascular therapy in patients was managed according to protocol. Data from four different phases (baseline, pre-recanalization, post recanalization, and post intervention) were obtained, and mean BP values, as well as changes in BP between different phases and reductions in systolic BP (SBP) and mean arterial pressure (MAP) from baseline to pre-recanalization, were used as exposure variables. The main outcome was a modified Rankin Scale score of 0–2 three months after admission. Secondary outcomes were successful reperfusion and change in the National Institutes of Health Stroke Scale score after 24 h. Multivariable linear and logistic regression models were used for statistical analysis. Results Functional outcomes were analyzed in 139 patients with successful reperfusion (defined as thrombolysis in cerebral infarction grade 2b–3). The mean (standard deviation) age was 76 (10.9) years, the mean (standard deviation) National Institutes of Health Stroke Scale score was 14.3 (7.5), and 70 (43.5%) patients had a left-sided vessel occlusion. Favorable functional outcome (modified Rankin Scale score 0–2) was less likely with every 10-mm Hg increase in baseline (odds ratio [OR] 0.76, P = 0.04) and pre-recanalization (OR 0.65, P = 0.011) SBP. This was also found for baseline (OR 0.76, P = 0.05) and pre-recanalization MAP (OR 0.66, P = 0.03). The maximum Youden index in a receiver operating characteristics analysis revealed an SBP of 163 mm Hg and MAP of 117 mm Hg as discriminatory thresholds during the pre-recanalization phase to predict functional outcome. Conclusions In our protocol-based setting, intraprocedural pre-recanalization BP reductions during endovascular therapy were not associated with functional outcome. However, higher intraprocedural pre-recanalization SBP and MAP were associated with worse functional outcome. Prospective randomized controlled studies are needed to determine whether BP is a feasible treatment target for the modification of outcomes.

Download Full-text

Abstract WP68: Tissue Type Plasminogen Activator (t-PA) and Edaravone Combination Therapy Study (YAMATO Study)

Stroke ◽

10.1161/str.47.suppl_1.wp68 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Junya Aoki ◽

Kazumi Kimura ◽

Norifumi Metoki ◽

Yohei Tateishi ◽

Kenichi Todo ◽

...

Keyword(s):

Clinical Outcome ◽

Arterial Occlusion ◽

Artery Occlusion ◽

Free Radical Scavenger ◽

Favorable Outcome ◽

Tissue Type ◽

Radical Scavenger ◽

Stroke Patients ◽

Symptomatic Intracerebral Hemorrhage ◽

Favorable Clinical Outcome

Introduction&Hypothesis: The aim of the present study was to investigate whether administration of edaravone, a free radical scavenger, before or during t-PA administration can increase the rate of early recanalization and improve the clinical outcome in stroke patients with major arterial occlusion. Methods: YAMATO study is an investigator initiated, multicenter (17 hospitals in Japan), prospective, randomized, open labeled study. Acute stroke patients with horizontal (M1) or vertical (M2) portion of the middle cerebral artery occlusion within 4.5 h of onset were studied. The subjects were randomly allocated to the early edaravone (early-E) group (intravenous edaravone [30 mg] was started before or during t-PA administration) and the late edaravone (late-E) group (edaravone was started after t-PA administration). Primary outcome, defined as any early recanalization 1h after t-PA therapy. Secondary outcomes included the rate of the significant recanalization, defined as ≥50% of the territory of the occluded artery on magnetic resonance angiography, or the thrombolysis in cerebral infarction score ≥2b on digital subtraction angiography as well as the incidence of symptomatic intracerebral hemorrhage (sICH), and the favorable clinical outcome (modified Rankin scale [mRS] of 0-2) at 3 months after onset. Results: One-hundred and sixty-six patients (96 men; median age [interquartile range], 78 [69-85] years) were randomized 1:1 to either the early-E group or the late-E group. Twenty-three (13.9%) had proximal M1 occlusion; 60 (36.1%), distal M1 occlusion; 83 (50%), M2 occlusion. Early recanalization was similarly observed in the early-E group and in the late-E group (53.1% vs. 53.0%, P=1.000). The rate of significant recanalization was also similar between the 2 groups (27.2% vs. 33.7%, p=0.399). sICH was occurred in 4 (4.8%) patients in the early-E group and in 2 (2.4%) in the late-E group (p=0.682). Among the 144 patients who were pre-morbid mRS of 0-2 and eligible for 3 months assessment, favorable outcome was seen in 53.9% in the early-E group and 57.4% in the late-E group (p=0.738) Conclusions: The timing of the edaravone infusion should not affect the rate of early recanalization, sICH, or favorable outcome after t-PA therapy.

Download Full-text

The impact of leptomeningeal collaterals in acute ischemic stroke

10.21203/rs.3.rs-36392/v1 ◽

2020 ◽

Author(s):

Nida Fatima ◽

Maher Saqqur ◽

Ashfaq Shuaib

Keyword(s):

Blood Flow ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Mesh Terms ◽

Favorable Clinical Outcome ◽

The Impact

Abstract Objectives: Leptomeningeal collaterals provide an alternate pathway to maintain cerebral blood flow in stroke to prevent ischemia, but their role in predicting outcome is still unclear. So, our study aims at assessing the significance of collateral blood flow (CBF) in acute stroke. Methods: Electronic databases were searched under different MeSH terms from Jan 2000 to Feb 2019. Studies were included if there was available data on good and poor CBF in acute ischemic stroke (AIS). The clinical outcomes included were modified rankin scale (mRS), recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) at 90 days. Data was analyzed using random-effect model.Results: A total of 47 studies with 8,194 patients were included. Pooled meta-analysis revealed that there exist 2-fold higher likelihood of favorable clinical outcome (mRS≤2) at 90 days with good CBF compared with poor CBF (RR: 2.27; 95%CI: 1.94-2.65; p<0.00001) irrespective of the thrombolytic therapy [RR with IVT: 2.90; 95%CI: 2.14-3.94; p<0.00001, and RR with IAT/EVT: 1.99; 95% CI: 1.55-2.55; p<0.00001]. Moreover, there exists 1-fold higher probability of successful recanalization with good CBF (RR: 1.31; 95% CI: 1.15-1.49; p<0.00001). However, there was 54% and 64% lower risk of sICH and mortality respectively in patients with good CBF in AIS (p<0.00001).Conclusions: The relative risk of favorable clinical outcome is more in patients with good pretreatment CBF. This could be explained due to better chances of recanalization, combined with lesser risk of intracerebral hemorrhage in good CBF status.

Download Full-text