Angiographic Demarcation of an Occlusive Lesion May Predict Recanalization after Intra‐arterial Thrombolysis in Patients with Acute Middle Cerebral Artery Occlusion

Otsuka, Yoshinobu; Waki, Riichiro; Fukazawa, Seiji; Kimura, Kohji; Shimizu, Kotoyuki; Fukuyama, Hidenao

doi:10.1111/j.1552-6569.2007.00209.x

Cited by 12 publications

(17 citation statements)

References 26 publications

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“…27,28 For prevalence data such as mortality rate, we used the standard normal method to estimate SDs. 27 Our primary end point was the mean mRS score for each study. Where an interval of mRS scores was reported for a group of subjects such as 3 to 5, we used linear interpolation and scored the group as 4.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Outcome After Ischemic Stroke Due to Anterior Circulation Occlusion Treated With Intravenous, Intra-Arterial, or Combined Intravenous+Intra-Arterial Thrombolysis

Mullen

Pisapia

Tilwa

et al. 2012

Stroke

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Background and Purpose-The optimal approach to recanalization in acute ischemic stroke is unknown. We performed a literature review and meta-analysis comparing the relative efficacy of 6 reperfusion strategies: (1) 0.9 mg/kg intravenous tissue-type plasminogen activator; (2) intra-arterial chemical thrombolysis; (3) intra-arterial mechanical thrombolysis; (4) intra-arterial combined chemical/mechanical thrombolysis; (5) 0.6 mg/kg intravenous tissue-type plasminogen activator and intra-arterial thrombolysis; and (6) 0.9 mg/kg intravenous tissue-type plasminogen activator and intra-arterial thrombolysis. Methods-A literature search in Medline, Embase, and the Cochrane database identified case series, observational studies, and treatment arms of randomized trials of anterior circulation arterial occlusion treated with thrombolytic therapy. Included studies had Ն10 subjects, mean time to treatment Ͻ6 hours, and treatment specific reporting of disability, death, and intracerebral hemorrhage. Multivariable metaregression evaluated the effects of treatment group on outcome at the same time as accounting for differences in baseline covariates. Results-A total of 2986 abstracts were identified from which 54 studies (5019 subjects) were included. There were significant differences across groups in age (Pϭ0.0008), baseline National Institutes of Health Stroke Scale (Pϭ0.0002), and time to treatment initiation (PϽ0.0001). There were also differences in mean modified Rankin Scale (PϽ0.0001), mortality (Pϭ0.0024), and symptomatic intracerebral hemorrhage (Pϭ0.0305). Differences in modified Rankin Scale were not significant in the metaregression and likely attributable to differences in baseline covariates between studies. Key Words: infarction Ⅲ meta-analysis Ⅲ thrombolysis Ⅲ thrombectomy S troke is the fourth leading cause of death in the United States and a leading cause of disability. 1 Stroke due to large-artery occlusion has a particularly poor prognosis with higher rates of death and disability than other stroke subtypes. 2-4 Current acute ischemic stroke interventions attempt to recanalize occluded arteries thereby restoring cerebral blood flow and improving functional outcome. The most well studied of these therapies is intravenous (IV) tissue-type plasminogen activator (tPA). Alternative strategies are available and have been used in both clinical practice and clinical research, including intra-arterial (IA) thrombolysis (chemical/ mechanical) and combined IVϩIA thrombolysis; however, the relative efficacy of these approaches is unknown. [5][6][7][8] IV tPA is recommended as the first-line therapy for patients with acute ischemic stroke presenting within 4.5 hours of symptom onset. 9,10 Unfortunately, recanalization rates with IV tPA are low when a large-artery occlusion is present with rates ranging from 4% to 68% depending on the study and the location of the occlusion. 11-13 A recent meta-analysis found a 46% recanalization rate overall with IV tPA. Small studies suggest that endovascular thrombolysis may be a fea...

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Section: Discussionmentioning

confidence: 99%

Systematic Review of Outcome After Ischemic Stroke Due to Anterior Circulation Occlusion Treated With Intravenous, Intra-Arterial, or Combined Intravenous+Intra-Arterial Thrombolysis

Mullen

Pisapia

Tilwa

et al. 2012

Stroke

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“…Even in cases with complete occlusion of an artery, it has been noted that tram-tracking may be present with small, persistent channels of flow lining the peripheral aspects of the clot along the vessel wall. 4 These diminutive flow routes visible with transcranial Doppler ultrasound (TCD) or angiographic techniques may play an important role in allowing thrombolytic access to the clot surface. Although ischemia is typically associated with arterial occlusion, venous obstruction can also result in ischemia.…”

Section: Occlusionmentioning

confidence: 99%

Imaging the future of stroke: I. Ischemia

Liebeskind

2009

Annals of Neurology

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Envisioning the future of stroke appears daunting considering the milestones already achieved in stroke imaging. A historical perspective on the developments in stroke care provides a striking narrative of how imaging has transformed diagnosis, therapy, and prognosis of cerebrovascular disorders. Multimodal imaging techniques such as CT and MRI, incorporating parenchymal depictions, illustration of the vasculature, and perfusion data, can provide a wealth of information regarding ischemic pathophysiology. Key elements of ischemic pathophysiology depicted with imaging include vascular occlusion, compensatory collateral flow, resultant hemodynamic conditions that reflect these sources of blood flow, and the neurovascular injury that ensues. The mantra of "time is brain" has been perpetuated, but this does not provide an entirely accurate reflection of ischemic pathophysiology and imaging insight shows far more than time alone. Maximizing the potential of perfusion imaging will continue to expand the nascent concept that cerebral ischemia may be completely reversible in certain scenarios. Novel modalities provide a fertile ground for discovery of therapeutic targets and the potential to assess effects of promising strategies. Beyond clinical trials, imaging has become a requisite component of the neurological examination enabling tailored stroke therapy with the use of detailed neuroimaging modalities. In this first article on ischemia, the focus is on the most recent imaging advances and exploring aspects of cerebral ischemia where imaging may yield additional therapeutic strategies. A subsequent article will review recent and anticipated imaging advances in hemorrhage. These thematic overviews underscore that imaging will undoubtedly continue to dramatically shape the future of stroke.

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“…This finding is described as ‘tram tracking’ which indicates a minimal degree of flow in occluded lesions 26 . Not only does revascularization and recanalization play a role in the reperfusion of ischemic tissue but collateral circulation is also thought to interplay with the vascular milieu and contribute to the support of tissue perfusion 27,28 .…”

Section: Angiographic Assessment Of Vascular Lesionsmentioning

confidence: 99%

Imaging of Cerebral Ischemia

Nour¹,

Liebeskind²

2014

Neurologic Clinics

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Angiographic Demarcation of an Occlusive Lesion May Predict Recanalization after Intra‐arterial Thrombolysis in Patients with Acute Middle Cerebral Artery Occlusion

Abstract: In acute MCA occlusion, our classification may indicate the difficulty of the recanalization procedure, and may assist in patient triage for different intra-arterial treatment strategies.

Cited by 12 publications

References 26 publications

Systematic Review of Outcome After Ischemic Stroke Due to Anterior Circulation Occlusion Treated With Intravenous, Intra-Arterial, or Combined Intravenous+Intra-Arterial Thrombolysis

Systematic Review of Outcome After Ischemic Stroke Due to Anterior Circulation Occlusion Treated With Intravenous, Intra-Arterial, or Combined Intravenous+Intra-Arterial Thrombolysis

Imaging the future of stroke: I. Ischemia

Imaging of Cerebral Ischemia

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