8
|
Lee SJ, Park SY, Hong JM, Choi JW, Kang DH, Kim YW, Kim YS, Hong JH, Kim CH, Yoo J, Nogueira RG, Hwang YH, Sohn SI, Lee JS. Etiological Approach to Understanding Recanalization Failure in Intracranial Large Vessel Occlusion and Thrombectomy: Close to Embolism but Distant From Atherosclerosis. Front Neurol 2021; 11:598216. [PMID: 33536994 PMCID: PMC7848124 DOI: 10.3389/fneur.2020.598216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction: In patients with intracranial large vessel occlusion (LVO) who undergo endovascular treatment (EVT), recanalization failure may be related to intracranial atherosclerotic stenosis (ICAS). We evaluated whether the risk factors of recanalization failure could possibly be a marker of ICAS among various types of LVO. Methods: From a multicenter registry, patients with middle cerebral artery M1 segment occlusions who underwent thrombectomy within 24 h were included. Based on the on-procedure and post-procedure angiographic findings, patients were classified into embolic, ICAS-related, tandem occlusion, and recanalization failure groups. Recanalization failure was defined if the occluded vessel could not be recanalized by stent retrieval, contact aspiration, or local lytics treatment. Risk factors, imaging markers, and EVT methods were compared between groups. Results: Among 326 patients, 214 were classified as embolism, 76 as ICAS, 16 as tandem, and 20 as recanalization failure. The group with recanalization failure showed higher scores on the National Institutes of Health Stroke Scale (NIHSS) (median, 16.0 vs. 14.5 vs. 14.0 vs. 17.0, p = 0.097), frequent atrial fibrillation (59.3 vs. 18.4 vs. 0 vs. 40.0% p < 0.001), and elevation in erythrocyte sedimentation rate (ESR) (14.5 ± 15.7 vs. 15.0 ± 14.1 vs. 21.2 ± 19.5 vs. 36.0 ± 32.9, p < 0.001) among the groups. The rate of computed tomography angiography-based truncal-type occlusion in recanalization failure group was not as high as that in the ICAS group (8.1 vs. 37.5 vs. 0 vs. 16.7%, p < 0.001). Balloon guide catheters (BGC) were less frequently utilized in the recanalization failure group as compared to their use in the other groups (72.0 vs. 72.4 vs. 62.5 vs. 30.0%, p = 0.001). In the multivariable analysis, initial higher NIHSS [odds ratio (OR), 1.11 95% confidence interval (CI), 1.01–1.22 p = 0.027], higher ESR (OR, 1.03 CI, 1.01–1.05 p = 0.006), and non-use of BGCs (OR, 3.41 CI, 1.14–10.17 p = 0.028) were associated with recanalization failure. In M1 occlusions, the predominant mechanism of recanalization failure was presumed to be embolic in 80% and due to ICAS in 20%. Conclusion: The analysis of recanalization failures does not suggest an underlying predominant ICAS mechanism. Sufficient utilization of thrombectomy devices and procedures may improve the rates of recanalization.
Collapse
Affiliation(s)
- Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - So Young Park
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong-Won Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong-Sun Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Joonsang Yoo
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea.,Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Raul G Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, United States
| | - Yang-Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| |
Collapse
|
11
|
Lee SJ, Hong JM, Choi JW, Park JH, Park B, Kang DH, Kim YW, Kim YS, Hong JH, Yoo J, Kim CH, Sohn SI, Hwang YH, Lee JS. Predicting Endovascular Treatment Outcomes in Acute Vertebrobasilar Artery Occlusion: A Model to Aid Patient Selection from the ASIAN KR Registry. Radiology 2020; 294:628-637. [PMID: 31990269 DOI: 10.1148/radiol.2020191227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The decision to perform endovascular treatment (EVT) for stroke related to vertebrobasilar occlusion (VBO) remains controversial. Purpose To identify preprocedural predictors of good outcomes and to develop a model to aid patient selection for VBO. Materials and Methods For this retrospective study using a Korean multicenter registry, a predictive model for good outcomes (modified Rankin scale score, 0-2) was generated based on a derivation sample of patients with VBO (January 2011-February 2016). Preprocedural parameters, including onset-to-puncture time, infarct volume, occlusion type as a surrogate marker of intracranial atherosclerotic stenosis-related occlusion or embolic occlusion (truncal-type occlusion vs branching site occlusion), and collateral status, were analyzed. Continuous variables were dichotomized based on receiver operating characteristic analysis. Multiple logistic regression analysis was performed to generate a predictive model. The model was internally validated with the bootstrap method and was externally validated with a single-center sample (April 2016-December 2018). Results A predictive model was generated from 71 patients (mean age, 67 years ± 11 [standard deviation]; 41 [58%] men) and was externally validated in 32 patients (mean age, 72 years ± 13; 19 [59%] men). The composite of initial DW imaging volume of less than 10 mL (odds ratio [OR], 19.3; 95% confidence interval [CI]: 3.0, 126.4; P = .002), onset-to-puncture time of less than 8 hours (OR, 8.7; 95% CI: 1.8, 42.0; P = .007), and branching-site occlusion (OR, 6.1; 95% CI: 1.5, 26.0; P = .01) could be used to predict good outcomes, with a median area under the receiver operating characteristic curve of 0.86 (interquartile range [IQR], 0.77-0.95; bootstrap optimism-corrected C statistic, 0.837) in the derivation sample and 0.78 (IQR, 0.62-0.95) in the validation sample. Results failed to show an association between collateral status and outcome (P = .67). Conclusion When selecting patients with vertebrobasilar occlusion for endovascular treatment, the combination of onset-to-puncture time of less than 8 hours, initial infarct volume of less than 10 mL, and presence of branching-site occlusions is indicative of a good outcome. © RSNA, 2020 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Seong-Joon Lee
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Ji Man Hong
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jin Wook Choi
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Ji Hyun Park
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bumhee Park
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Dong-Hun Kang
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yong-Won Kim
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yong-Sun Kim
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jeong-Ho Hong
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Joonsang Yoo
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Chang-Hyun Kim
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sung-Il Sohn
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yang-Ha Hwang
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jin Soo Lee
- From the Departments of Neurology (S.J.L., J.M.H., J.S.L.), Radiology (J.W.C.), and Biomedical Informatics (B.P.), Ajou University School of Medicine, and Office of Biostatistics, Ajou Research Institute for Innovative Medicine (J.H.P., B.P.), Ajou University Medical Center, 164 World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea; Departments of Neurosurgery (D.H.K.), Radiology (D.H.K., Y.W.K., Y.S.K.), and Neurology (Y.W.K., Y.H.H.), School of Medicine, Kyungpook National University, Daegu, Republic of Korea; and Departments of Neurology (J.H.H., J.Y., S.I.S.) and Neurosurgery (C.H.K.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| |
Collapse
|