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Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular Treatment
BACKGROUND AND PURPOSE: Little is known about prognosis after endovascular therapy (EVT) for acute large artery occlusion (LAO) caused by underlying intracranial atherosclerotic stenosis (ICAS). Therefore, we investigated the prognosis following EVT according to the underlying etiology of LAO. METHO...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Stroke Society
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186924/ https://www.ncbi.nlm.nih.gov/pubmed/30309234 http://dx.doi.org/10.5853/jos.2018.01627 |
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author | Lee, Jin Soo Lee, Seong-Joon Yoo, Joon Sang Hong, Jeong-Ho Kim, Chang-Hyun Kim, Yong-Won Kang, Dong-Hun Kim, Yong-Sun Hong, Ji Man Choi, Jin Wook Ovbiagele, Bruce Demchuk, Andrew M. Sohn, Sung-Il Hwang, Yang-Ha |
author_facet | Lee, Jin Soo Lee, Seong-Joon Yoo, Joon Sang Hong, Jeong-Ho Kim, Chang-Hyun Kim, Yong-Won Kang, Dong-Hun Kim, Yong-Sun Hong, Ji Man Choi, Jin Wook Ovbiagele, Bruce Demchuk, Andrew M. Sohn, Sung-Il Hwang, Yang-Ha |
author_sort | Lee, Jin Soo |
collection | PubMed |
description | BACKGROUND AND PURPOSE: Little is known about prognosis after endovascular therapy (EVT) for acute large artery occlusion (LAO) caused by underlying intracranial atherosclerotic stenosis (ICAS). Therefore, we investigated the prognosis following EVT according to the underlying etiology of LAO. METHODS: Patients from the Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention-Korean Retrospective (ASIAN KR) registry (n=720) were included if their occlusion was in the intracranial anterior circulation and their onset-to-puncture time was <24 hours. Occlusion was classified according to etiology as follows: no significant stenosis after recanalization (Embolic group), and fixed significant focal stenosis in the occlusion site with flow impairment or re-occlusion observed during EVT (ICAS group). Patients were excluded when significant extracranial carotid lesions existed, and when the intracranial occlusion was intractable to EVT so that the etiology was undetermined. The effect of angiographic etiologic classification on outcomes was evaluated using multivariable analysis that was adjusted for potential confounders. RESULTS: Among eligible patients (n=520), 421 and 99 were classified in the Embolic and ICAS groups, respectively. Patients in the Embolic and ICAS groups had similar successful reperfusion rates with EVT (79.6% vs. 76.8%, P=0.537) and 3-month functional independence (54.5% vs. 45.5%, P=0.104). In multivariable analysis, ICAS-related occlusion (odds ratio, 0.495; 95% confidence interval, 0.269 to 0.913; P=0.024) showed poorer 3-month functional independence compared to embolic occlusion. CONCLUSIONS: After EVT, patients with acute ICAS-related occlusion have relatively poor functional outcomes compared to those with embolic occlusion. Novel strategies need to be developed to improve EVT outcomes for ICAS occlusion. |
format | Online Article Text |
id | pubmed-6186924 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Korean Stroke Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-61869242018-10-23 Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular Treatment Lee, Jin Soo Lee, Seong-Joon Yoo, Joon Sang Hong, Jeong-Ho Kim, Chang-Hyun Kim, Yong-Won Kang, Dong-Hun Kim, Yong-Sun Hong, Ji Man Choi, Jin Wook Ovbiagele, Bruce Demchuk, Andrew M. Sohn, Sung-Il Hwang, Yang-Ha J Stroke Original Article BACKGROUND AND PURPOSE: Little is known about prognosis after endovascular therapy (EVT) for acute large artery occlusion (LAO) caused by underlying intracranial atherosclerotic stenosis (ICAS). Therefore, we investigated the prognosis following EVT according to the underlying etiology of LAO. METHODS: Patients from the Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention-Korean Retrospective (ASIAN KR) registry (n=720) were included if their occlusion was in the intracranial anterior circulation and their onset-to-puncture time was <24 hours. Occlusion was classified according to etiology as follows: no significant stenosis after recanalization (Embolic group), and fixed significant focal stenosis in the occlusion site with flow impairment or re-occlusion observed during EVT (ICAS group). Patients were excluded when significant extracranial carotid lesions existed, and when the intracranial occlusion was intractable to EVT so that the etiology was undetermined. The effect of angiographic etiologic classification on outcomes was evaluated using multivariable analysis that was adjusted for potential confounders. RESULTS: Among eligible patients (n=520), 421 and 99 were classified in the Embolic and ICAS groups, respectively. Patients in the Embolic and ICAS groups had similar successful reperfusion rates with EVT (79.6% vs. 76.8%, P=0.537) and 3-month functional independence (54.5% vs. 45.5%, P=0.104). In multivariable analysis, ICAS-related occlusion (odds ratio, 0.495; 95% confidence interval, 0.269 to 0.913; P=0.024) showed poorer 3-month functional independence compared to embolic occlusion. CONCLUSIONS: After EVT, patients with acute ICAS-related occlusion have relatively poor functional outcomes compared to those with embolic occlusion. Novel strategies need to be developed to improve EVT outcomes for ICAS occlusion. Korean Stroke Society 2018-09 2018-09-30 /pmc/articles/PMC6186924/ /pubmed/30309234 http://dx.doi.org/10.5853/jos.2018.01627 Text en Copyright © 2018 Korean Stroke Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Lee, Jin Soo Lee, Seong-Joon Yoo, Joon Sang Hong, Jeong-Ho Kim, Chang-Hyun Kim, Yong-Won Kang, Dong-Hun Kim, Yong-Sun Hong, Ji Man Choi, Jin Wook Ovbiagele, Bruce Demchuk, Andrew M. Sohn, Sung-Il Hwang, Yang-Ha Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular Treatment |
title | Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular Treatment |
title_full | Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular Treatment |
title_fullStr | Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular Treatment |
title_full_unstemmed | Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular Treatment |
title_short | Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular Treatment |
title_sort | prognosis of acute intracranial atherosclerosis-related occlusion after endovascular treatment |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186924/ https://www.ncbi.nlm.nih.gov/pubmed/30309234 http://dx.doi.org/10.5853/jos.2018.01627 |
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