Year: 2016
Type: article
Abstract: OBJECTIVE: To assess whether the association between reperfusion and improved clinical outcomes after stroke differs depending on the site of the arterial occlusive lesion (AOL). METHODS: We pooled data from Solitaire With the Intention for Thrombectomy (SWIFT), Solitaire FR Thrombectomy for Acute Revascularisation (STAR), Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2 (DEFUSE 2), and Interventional Management of Stroke Trial (IMS III) to compare the strength of the associations between reperfusion and clinical outcomes in patients with internal carotid artery (ICA), proximal middle cerebral artery (MCA) (M1), and distal MCA (M2/3/4) occlusions. RESULTS: Among 710 included patients, the site of the AOL was the ICA in 161, the proximal MCA in 389, and the distal MCA in 160 patients (M2 = 131, M3 = 23, and M4 = 6). Reperfusion was associated with an increase in the rate of good functional outcome (modified Rankin Scale [mRS] score 0-2) in patients with ICA (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.7-7.2) and proximal MCA occlusions (OR 6.2, 95% CI 3.8-10.2), but not in patients with distal MCA occlusions (OR 1.4, 95% CI 0.8-2.6). Among patients with M2 occlusions, a subset of the distal MCA cohort, reperfusion was associated with excellent functional outcome (mRS 0-1; OR 2.2, 95% CI 1.0-4.7). CONCLUSIONS: The association between endovascular reperfusion and better clinical outcomes is more profound in patients with ICA and proximal MCA occlusions compared to patients with distal MCA occlusions. Because there are limited data from randomized controlled trials on the effect of endovascular therapy in patients with distal MCA occlusions, these results underscore the need for inclusion of this subgroup in future endovascular therapy trials.
Source: Neurology
Authors: Robin Lemmens, Scott A. Hamilton, David S. Liebeskind, Tom A. Tomsick, Andrew M. Demchuk, Raul G. Nogueira, Michael P. Marks, Reza Jahan, Jan Gralla, Albert J. Yoo, Sharon D. Yeatts, Yuko Y. Palesch, Jeffrey L. Saver, Vitor M. Pereira, Joseph P. Broderick, Gregory W. Albers, Maarten G. Lansberg, For the DEFUSE 2, IMS III, STAR, and SWIFT trialists, DEFUSE 2, IMS III, STAR, and SWIFT trialists, Scott A Hamilton, Michael P Marks, Gregory W Albers, Maarten G Lansberg, David S Liebeskind, Tom A Tomsick, Andrew M Demchuck, Sharon D Yeatts, Yuko Y Palesch, Joseph P Broderick, Raul G Nogueira, David S Liebeskind, Jan Gralla, Vitor M Pereira, Raul G Nogueira, David S Liebeskind, Reza Jahan, Raul G Nogueira, Jeffrey L Saver
Institutions: Grady Memorial Hospital, University Health Network, Harvard University, Emory University, Medical University of South Carolina, University of Calgary, Toronto Western Hospital, Universitair Ziekenhuis Leuven, University Hospital of Bern, Massachusetts General Hospital, Stanford Medicine, Hotchkiss Brain Institute, University of Cincinnati Medical Center, Stanford University, KU Leuven, University of California, Los Angeles
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2322584752