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BMC Neurol. 2019 Jan 15;19(1):11. doi: 10.1186/s12883-019-1237-2.

Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity.

Author information

1
Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
2
Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
3
Department of Neurology, Seoul Medical Center, Seoul, Korea.
4
Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
5
Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
6
Department of Neurology, Dong-A University Hospital, Pusan, Korea.
7
Department of Neurology, Yeungnam University Medical Center, Daegu, Korea.
8
Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
9
Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
10
Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea.
11
Department of Neurology, Jeju National University, Jeju, Korea.
12
Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
13
Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
14
Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
15
Department of Neurology, Chungbuk National University College of Medicine, Cheongju, Korea.
16
Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea.
17
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
18
Clinical Research Center, Asan Medical Center, Seoul, Korea.
19
Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
20
Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea. braindoc@snu.ac.kr.

Abstract

BACKGROUND:

Futile reperfusion (poor functional status despite successful reperfusion) was observed in up to 67% of patients enrolled in recent endovascular treatment (EVT) clinical trials. We investigated the impact of baseline stroke severity on both futile reperfusion and therapeutic benefit of successful EVT.

METHODS:

Using a prospective multicenter stroke registry, we identified consecutive ischemic stroke patients with anterior circulation large artery occlusion, who were reperfused successfully by EVT (Thrombolysis in Cerebral Infarction grade 2b-3). The rate of futile reperfusion was assessed across the initial National Institutes of Health Stroke Scale (NIHSS) scores. The frequency of poor outcomes (modified Rankin scale [mRS] 3-6) according to NIHSS scores was compared between patients revascularized successfully by EVT and those who did not receive EVT, after standardizing for age.

RESULTS:

Among 21,591 patients with ischemic stroke, 972 (4.5%) received EVT within 12 h of onset, including 440 who met study eligibility criteria. Futile reperfusion was observed in 226 of the 440 study-eligible patients (51.4%) and was associated with stroke severity: 20.9% in NIHSS scores ≤5, 34.6% in 6-10, 58.9% in 11-20, and 63.8% in > 20 (p < 0.001). Nonetheless, the therapeutic benefit of EVT also increased with increasing stroke severity (p for interaction < 0.001): 0.1% in NIHSS ≤5, 18.6% in 6-10, 28.7% in 11-20, and 34.3% in > 20.

CONCLUSIONS:

EVT is more beneficial with increasing stroke severity, although futile reperfusion also increases with higher stroke severity.

KEYWORDS:

Endovascular treatment; Futile reperfusion; Stroke severity; Therapeutic benefit

PMID:
30646858
PMCID:
PMC6332890
DOI:
10.1186/s12883-019-1237-2
[Indexed for MEDLINE]
Free PMC Article

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