Association of Clinical, Imaging, and Thrombus Characteristics
With Recanalization of Visible Intracranial Occlusion in
Patients With Acute Ischemic Stroke

J 2018

Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke

MENON, Bijoy K., Fahad S. AL-AJLAN, Mohamed NAJM, Josep PUIG, Mar CASTELLANOS et. al.

Basic information

Original name

Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke

Authors

MENON, Bijoy K. (124 Canada), Fahad S. AL-AJLAN (682 Saudi Arabia), Mohamed NAJM (724 Spain), Josep PUIG (724 Spain), Mar CASTELLANOS (724 Spain), Dar DOWLATSHAHI (124 Canada), Ana CALLEJA (724 Spain), Sung Il SOHN (410 Republic of Korea), Seong H. AHN (410 Republic of Korea), Alex POPPE (124 Canada), Robert MIKULÍK (203 Czech Republic, belonging to the institution), Negar ASDAGHI (840 United States of America), Thalia S. FIELD (124 Canada), Albert JIN (124 Canada), Talip ASIL (792 Turkey), Jean Martin BOULANGER (124 Canada), Eric E. SMITH (124 Canada), Shelag B. COUTTS (124 Canada), Phil A. BARBER (124 Canada), Simerpreet BAL (124 Canada), Suresh SUBRAMANIAN (124 Canada), Sachin MISHRA (36 Australia), Anurag TRIVEDI (124 Canada), Sadanand DEY (124 Canada), Muneer EESA (124 Canada), Tolulope SAJOBI (124 Canada), Mayank GOYAL (124 Canada), Michael D. HILL (124 Canada) and Andrew M. DEMCHUK (124 Canada, guarantor)

Edition

JAMA-Journal of the American Medical Association, Chicago, USA, American Medical Association, 2018, 0098-7484

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30210 Clinical neurology

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 51.273

RIV identification code

RIV/00216224:14110/18:00105510

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1001/jama.2018.12498

UT WoS

000444341400015

Keywords in English

Acute Ischemic Stroke

Abstract

V originále

IMPORTANCE Recanalization of intracranial thrombus is associated with improved clinical outcome in patients with acute ischemic stroke. The association of intravenous alteplase treatment and thrombus characteristics with recanalization over time is important for stroke triage and future trial design. OBJECTIVE To examine recanalization over time across a range of intracranial thrombus occlusion sites and clinical and imaging characteristics in patients with ischemic stroke treated with intravenous alteplase or not treated with alteplase. DESIGN, SETTING, AND PARTICIPANTS Multicenter prospective cohort study of 575 patients from 12 centers (in Canada, Spain, South Korea, the Czech Republic, and Turkey) with acute ischemic stroke and intracranial arterial occlusion demonstrated on computed tomographic angiography (CTA). EXPOSURES Demographics, clinical characteristics, time from alteplase to recanalization, and intracranial thrombus characteristics (location and permeability) defined on CTA. MAIN OUTCOMES AND MEASURES Recanalization on repeat CTA or on first angiographic acquisition of affected intracranial circulation obtained within 6 hours of baseline CTA, defined using the revised arterial occlusion scale (rAOL) (scores from 0 [primary occlusive lesion remains the same] to 3 [complete revascularization of primary occlusion]). RESULTS Among 575 patients (median age, 72 years [IQR, 63-80]; 51.5% men; median time from patient last known well to baseline CTA of 114 minutes [IQR, 74-180]), 275 patients (47.8%) received intravenous alteplase only, 195 (33.9%) received intravenous alteplase plus endovascular thrombectomy, 48 (8.3%) received endovascular thrombectomy alone, and 57 (9.9%) received conservative treatment. Median time from baseline CTA to recanalization assessment was 158 minutes (IQR, 79-268); median time from intravenous alteplase start to recanalization assessment was 132.5 minutes (IQR, 62-238). Successful recanalization occurred at an unadjusted rate of 27.3%(157/575) overall, including in 30.4%(143/470) of patients who received intravenous alteplase and 13.3%(14/105) who did not (difference, 17.1%[95% CI, 10.2%-25.8%]). Among patients receiving alteplase, the following factors were associated with recanalization: time from treatment start to recanalization assessment (OR, 1.28 for every 30-minute increase in time [95% CI, 1.18-1.38]), more distal thrombus location, eg, distal M1 middle cerebral artery (39/84 [46.4%]) vs internal carotid artery (10/92 [10.9%]) (OR, 5.61 [95% CI, 2.38-13.26]), and higher residual flow (thrombus permeability) grade, eg, hairline streak (30/45 [66.7%]) vs none (91/377 [24.1%]) (OR, 7.03 [95% CI, 3.32-14.87]). CONCLUSIONS AND RELEVANCE In patients with acute ischemic stroke, more distal thrombus location, greater thrombus permeability, and longer time to recanalization assessment were associated with recanalization of arterial occlusion after administration of intravenous alteplase; among patients who did not receive alteplase, rates of arterial recanalization were low. These findings may help inform treatment and triage decisions in patients with acute ischemic stroke.

Citovat

MENON, Bijoy K., Fahad S. AL-AJLAN, Mohamed NAJM, Josep PUIG, Mar CASTELLANOS, Dar DOWLATSHAHI, Ana CALLEJA, Sung Il SOHN, Seong H. AHN, Alex POPPE, Robert MIKULÍK, Negar ASDAGHI, Thalia S. FIELD, Albert JIN, Talip ASIL, Jean Martin BOULANGER, Eric E. SMITH, Shelag B. COUTTS, Phil A. BARBER, Simerpreet BAL, Suresh SUBRAMANIAN, Sachin MISHRA, Anurag TRIVEDI, Sadanand DEY, Muneer EESA, Tolulope SAJOBI, Mayank GOYAL, Michael D. HILL and Andrew M. DEMCHUK. Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke. JAMA-Journal of the American Medical Association. Chicago, USA: American Medical Association, 2018, vol. 320, No 10, p. 1017-1026. ISSN 0098-7484. Available from: https://dx.doi.org/10.1001/jama.2018.12498.

@article{1486787,
   author = {Menon, Bijoy K. and AlandAjlan, Fahad S. and Najm, Mohamed and Puig, Josep and Castellanos, Mar and Dowlatshahi, Dar and Calleja, Ana and Sohn, Sung Il and Ahn, Seong H. and Poppe, Alex and Mikulík, Robert and Asdaghi, Negar and Field, Thalia S. and Jin, Albert and Asil, Talip and Boulanger, Jean Martin and Smith, Eric E. and Coutts, Shelag B. and Barber, Phil A. and Bal, Simerpreet and Subramanian, Suresh and Mishra, Sachin and Trivedi, Anurag and Dey, Sadanand and Eesa, Muneer and Sajobi, Tolulope and Goyal, Mayank and Hill, Michael D. and Demchuk, Andrew M.},
   article_location = {Chicago, USA},
   article_number = {10},
   doi = {http://dx.doi.org/10.1001/jama.2018.12498},
   keywords = {Acute Ischemic Stroke},
   language = {eng},
   issn = {0098-7484},
   journal = {JAMA-Journal of the American Medical Association},
   title = {Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke},
   volume = {320},
   year = {2018}
}

TY  - JOUR
ID  - 1486787
AU  - Menon, Bijoy K. - Al-Ajlan, Fahad S. - Najm, Mohamed - Puig, Josep - Castellanos, Mar - Dowlatshahi, Dar - Calleja, Ana - Sohn, Sung Il - Ahn, Seong H. - Poppe, Alex - Mikulík, Robert - Asdaghi, Negar - Field, Thalia S. - Jin, Albert - Asil, Talip - Boulanger, Jean Martin - Smith, Eric E. - Coutts, Shelag B. - Barber, Phil A. - Bal, Simerpreet - Subramanian, Suresh - Mishra, Sachin - Trivedi, Anurag - Dey, Sadanand - Eesa, Muneer - Sajobi, Tolulope - Goyal, Mayank - Hill, Michael D. - Demchuk, Andrew M.
PY  - 2018
TI  - Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke
JF  - JAMA-Journal of the American Medical Association
VL  - 320
IS  - 10
SP  - 1017-1026
EP  - 1017-1026
PB  - American Medical Association
SN  - 00987484
KW  - Acute Ischemic Stroke
N2  - IMPORTANCE Recanalization of intracranial thrombus is associated with improved clinical outcome in patients with acute ischemic stroke. The association of intravenous alteplase treatment and thrombus characteristics with recanalization over time is important for stroke triage and future trial design. OBJECTIVE To examine recanalization over time across a range of intracranial thrombus occlusion sites and clinical and imaging characteristics in patients with ischemic stroke treated with intravenous alteplase or not treated with alteplase. DESIGN, SETTING, AND PARTICIPANTS Multicenter prospective cohort study of 575 patients from 12 centers (in Canada, Spain, South Korea, the Czech Republic, and Turkey) with acute ischemic stroke and intracranial arterial occlusion demonstrated on computed tomographic angiography (CTA). EXPOSURES Demographics, clinical characteristics, time from alteplase to recanalization, and intracranial thrombus characteristics (location and permeability) defined on CTA. MAIN OUTCOMES AND MEASURES Recanalization on repeat CTA or on first angiographic acquisition of affected intracranial circulation obtained within 6 hours of baseline CTA, defined using the revised arterial occlusion scale (rAOL) (scores from 0 [primary occlusive lesion remains the same] to 3 [complete revascularization of primary occlusion]). RESULTS Among 575 patients (median age, 72 years [IQR, 63-80]; 51.5% men; median time from patient last known well to baseline CTA of 114 minutes [IQR, 74-180]), 275 patients (47.8%) received intravenous alteplase only, 195 (33.9%) received intravenous alteplase plus endovascular thrombectomy, 48 (8.3%) received endovascular thrombectomy alone, and 57 (9.9%) received conservative treatment. Median time from baseline CTA to recanalization assessment was 158 minutes (IQR, 79-268); median time from intravenous alteplase start to recanalization assessment was 132.5 minutes (IQR, 62-238). Successful recanalization occurred at an unadjusted rate of 27.3%(157/575) overall, including in 30.4%(143/470) of patients who received intravenous alteplase and 13.3%(14/105) who did not (difference, 17.1%[95% CI, 10.2%-25.8%]). Among patients receiving alteplase, the following factors were associated with recanalization: time from treatment start to recanalization assessment (OR, 1.28 for every 30-minute increase in time [95% CI, 1.18-1.38]), more distal thrombus location, eg, distal M1 middle cerebral artery (39/84 [46.4%]) vs internal carotid artery (10/92 [10.9%]) (OR, 5.61 [95% CI, 2.38-13.26]), and higher residual flow (thrombus permeability) grade, eg, hairline streak (30/45 [66.7%]) vs none (91/377 [24.1%]) (OR, 7.03 [95% CI, 3.32-14.87]). CONCLUSIONS AND RELEVANCE In patients with acute ischemic stroke, more distal thrombus location, greater thrombus permeability, and longer time to recanalization assessment were associated with recanalization of arterial occlusion after administration of intravenous alteplase; among patients who did not receive alteplase, rates of arterial recanalization were low. These findings may help inform treatment and triage decisions in patients with acute ischemic stroke.
ER  -

MENON, Bijoy K., Fahad S. AL-AJLAN, Mohamed NAJM, Josep PUIG, Mar CASTELLANOS, Dar DOWLATSHAHI, Ana CALLEJA, Sung Il SOHN, Seong H. AHN, Alex POPPE, Robert MIKULÍK, Negar ASDAGHI, Thalia S. FIELD, Albert JIN, Talip ASIL, Jean Martin BOULANGER, Eric E. SMITH, Shelag B. COUTTS, Phil A. BARBER, Simerpreet BAL, Suresh SUBRAMANIAN, Sachin MISHRA, Anurag TRIVEDI, Sadanand DEY, Muneer EESA, Tolulope SAJOBI, Mayank GOYAL, Michael D. HILL and Andrew M. DEMCHUK. Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke. \textit{JAMA-Journal of the American Medical Association}. Chicago, USA: American Medical Association, 2018, vol.~320, No~10, p.~1017-1026. ISSN~0098-7484. Available from: https://dx.doi.org/10.1001/jama.2018.12498.

Detailed Information on Publication Record