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AJNR - American Journal of Neuroradiology

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Revascularization Results in the Interventional Management of Stroke II Trial

T. Tomsick^a, J. Broderick^b, J. Carrozella^a, P. Khatri^b, M. Hill^d, Y. Palesch^e, J. Khoury^c for the Interventional Management of Stroke II Investigators

^a Departments of Radiology, University of Cincinnati, Cincinnati, Ohio
^b Neurology, University of Cincinnati, Cincinnati, Ohio
^c Environmental Health, University of Cincinnati, Cincinnati, Ohio
^d Department of Clinical Neurosciences and Community Health Sciences, University of Calgary, Alberta, Canada
^e Department of Biostatistics, Bioformatics, and Epidemiology, University of South Carolina, Charleston, SC

View larger version (30K): [in this window] [in a new window]   Fig 1. Patient flow and treatment group designation for 81 subjects entered into IMS II.

View larger version (24K): [in this window] [in a new window]   Fig 2. Graph depicts total cumulative complete grade 3 AOL recanalization at each 15-minute interval for the EKOS Primo sonography microcatheter (n = 29) and the standard microcatheter in IMS II (n = 14). Standard microcatheter recanalization data points at 60 and 120 minutes are also depicted. IMS I data are incomplete at 60 minutes, with 23 confirmed control arteriograms. Sixty- and 120-minute IMS I data points closely approximate the line of IMS II microcatheter recanalization. The open circle emphasizes an early equivalence of standard microcatheter to the sonography (US) microcatheter. The greatest recanalization effect (>20%) is within the first 15 minutes of microcatheter placement.

View larger version (88K): [in this window] [in a new window]   Fig 3. Temperature (T) chart correlation to recanalization in M2 occlusion. Upper left: control arteriogram demonstrates EKOS sonography microcatheter placed in the M2 occlusion (white arrow) just before treatment time 0. Upper right: 15-minute control arteriogram demonstrates microcatheter tip retraction into the M1 segment (white arrow). Note the temperature decrease of approximately 0.2°C during the 15-minute time interval, indicating cooling of the catheter by flowing blood. Lower right: oblique 30-minute arteriogram with catheter-tip position (white arrow) proximal to recanalization of the M2 segment, with distal emboli (AOL 3 recanalization, TICI 2 perfusion). Note the temperature drop of approximately 0.4°C during the 15-minute time interval. The downward spikes of T indicate cooling by contrast injection. The spike at 25 minutes was an additional injection to confirm maintenance of catheter position, where no recanalization was yet identified. deg C indicates degrees celsius.