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Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion

BACKGROUND AND PURPOSE: We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. METHODS: Using data from two different multicenter prospective cohorts, we determined the factors associated with early recan...

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Autores principales: Kim, Young Dae, Nam, Hyo Suk, Yoo, Joonsang, Park, Hyungjong, Sohn, Sung-Il, Hong, Jeong-Ho, Kim, Byung Moon, Kim, Dong Joon, Bang, Oh Young, Seo, Woo-Keun, Chung, Jong-Won, Lee, Kyung-Yul, Jung, Yo Han, Lee, Hye Sun, Ahn, Seong Hwan, Shin, Dong Hoon, Choi, Hye-Yeon, Cho, Han-Jin, Baek, Jang-Hyun, Kim, Gyu Sik, Seo, Kwon-Duk, Kim, Seo Hyun, Song, Tae-Jin, Kim, Jinkwon, Han, Sang Won, Park, Joong Hyun, Lee, Sung Ik, Heo, JoonNyung, Choi, Jin Kyo, Heo, Ji Hoe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Stroke Society 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189851/
https://www.ncbi.nlm.nih.gov/pubmed/34102759
http://dx.doi.org/10.5853/jos.2020.03622
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author Kim, Young Dae
Nam, Hyo Suk
Yoo, Joonsang
Park, Hyungjong
Sohn, Sung-Il
Hong, Jeong-Ho
Kim, Byung Moon
Kim, Dong Joon
Bang, Oh Young
Seo, Woo-Keun
Chung, Jong-Won
Lee, Kyung-Yul
Jung, Yo Han
Lee, Hye Sun
Ahn, Seong Hwan
Shin, Dong Hoon
Choi, Hye-Yeon
Cho, Han-Jin
Baek, Jang-Hyun
Kim, Gyu Sik
Seo, Kwon-Duk
Kim, Seo Hyun
Song, Tae-Jin
Kim, Jinkwon
Han, Sang Won
Park, Joong Hyun
Lee, Sung Ik
Heo, JoonNyung
Choi, Jin Kyo
Heo, Ji Hoe
author_facet Kim, Young Dae
Nam, Hyo Suk
Yoo, Joonsang
Park, Hyungjong
Sohn, Sung-Il
Hong, Jeong-Ho
Kim, Byung Moon
Kim, Dong Joon
Bang, Oh Young
Seo, Woo-Keun
Chung, Jong-Won
Lee, Kyung-Yul
Jung, Yo Han
Lee, Hye Sun
Ahn, Seong Hwan
Shin, Dong Hoon
Choi, Hye-Yeon
Cho, Han-Jin
Baek, Jang-Hyun
Kim, Gyu Sik
Seo, Kwon-Duk
Kim, Seo Hyun
Song, Tae-Jin
Kim, Jinkwon
Han, Sang Won
Park, Joong Hyun
Lee, Sung Ik
Heo, JoonNyung
Choi, Jin Kyo
Heo, Ji Hoe
author_sort Kim, Young Dae
collection PubMed
description BACKGROUND AND PURPOSE: We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. METHODS: Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. RESULTS: Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). CONCLUSIONS: The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.
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spelling pubmed-81898512021-06-16 Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion Kim, Young Dae Nam, Hyo Suk Yoo, Joonsang Park, Hyungjong Sohn, Sung-Il Hong, Jeong-Ho Kim, Byung Moon Kim, Dong Joon Bang, Oh Young Seo, Woo-Keun Chung, Jong-Won Lee, Kyung-Yul Jung, Yo Han Lee, Hye Sun Ahn, Seong Hwan Shin, Dong Hoon Choi, Hye-Yeon Cho, Han-Jin Baek, Jang-Hyun Kim, Gyu Sik Seo, Kwon-Duk Kim, Seo Hyun Song, Tae-Jin Kim, Jinkwon Han, Sang Won Park, Joong Hyun Lee, Sung Ik Heo, JoonNyung Choi, Jin Kyo Heo, Ji Hoe J Stroke Original Article BACKGROUND AND PURPOSE: We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. METHODS: Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. RESULTS: Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). CONCLUSIONS: The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion. Korean Stroke Society 2021-05 2021-05-31 /pmc/articles/PMC8189851/ /pubmed/34102759 http://dx.doi.org/10.5853/jos.2020.03622 Text en Copyright © 2021 Korean Stroke Society https://creativecommons.org/licenses/by-nc/4.0/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/ (https://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
Kim, Young Dae
Nam, Hyo Suk
Yoo, Joonsang
Park, Hyungjong
Sohn, Sung-Il
Hong, Jeong-Ho
Kim, Byung Moon
Kim, Dong Joon
Bang, Oh Young
Seo, Woo-Keun
Chung, Jong-Won
Lee, Kyung-Yul
Jung, Yo Han
Lee, Hye Sun
Ahn, Seong Hwan
Shin, Dong Hoon
Choi, Hye-Yeon
Cho, Han-Jin
Baek, Jang-Hyun
Kim, Gyu Sik
Seo, Kwon-Duk
Kim, Seo Hyun
Song, Tae-Jin
Kim, Jinkwon
Han, Sang Won
Park, Joong Hyun
Lee, Sung Ik
Heo, JoonNyung
Choi, Jin Kyo
Heo, Ji Hoe
Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
title Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
title_full Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
title_fullStr Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
title_full_unstemmed Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
title_short Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
title_sort prediction of early recanalization after intravenous thrombolysis in patients with large-vessel occlusion
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189851/
https://www.ncbi.nlm.nih.gov/pubmed/34102759
http://dx.doi.org/10.5853/jos.2020.03622
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