American Journal of Neuroradiology 2008;29:253.
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American Journal of Neuroradiology
DOI 10.3174/ajnr.A0825
INTERVENTIONAL
Impact of Arterial Reocclusion and Distal Fragmentation during Thrombolysis among Patients with Acute Ischemic Stroke
From the Department of Neurology (N.J.), Long Island College Hospital and State University of New York Health Science Center at Brooklyn, Brooklyn, NY; Department of Neurology and Neurosciences (A.A.), University of Medicine and Dentistry of New Jersey, Newark, NJ; and Department of Neurology (M.F.K.S., A.I.Q.), the Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minn.
Please address correspondence to N. Janjua, MD, Long Island College Hospital, Department of Neurology, 339 Hicks St, Brooklyn, NY 11201; e-mail: NJanjua{at}chpnet.org
BACKGROUND AND PURPOSE: Arterial reocclusion and distal embolization are known complications of ischemic stroke intervention, impacting treatment strategies and device design. We sought to determine their rates of occurrence and effects on long-term outcomes during endovascular treatment of patients with acute ischemic stroke.
MATERIALS AND METHODS: Retrospective analysis of data from 4 prospective acute stroke protocols was performed. Patients underwent the standard technique for parent vessel angiography followed by pharmacologic thrombolysis and/or sonographic thrombolysis and/or mechanical thrombus disruption. Certain patients also received systemic heparin or abciximab therapy. Demographic, clinical, and angiographic variables were assessed at onset, 24 hours, 1 week, and 1–3 months after the event. "Distal embolization" was defined qualitatively as appearance of an occlusion on a downstream vessel. "Arterial reocclusion" was defined as subsequent reocclusion of the target vessel after initial recanalization had been achieved.
RESULTS: Arterial reocclusion occurred in 18% of these patients, whereas distal embolization occurred in 16% of the 91 patients treated in these protocols. Arterial reocclusion, but not distal embolization, was associated with a lower likelihood of favorable outcome at 1–3 months (P = .05; odds ratio, 3.9; 95% confidence interval, 0.01–0.98) after adjusting for age, initial National Institutes of Health Stroke Scale scores, sex, time to treatment, initial angiographic grade, symptomatic intracranial hemorrhage, and final recanalization.
CONCLUSIONS: Arterial reocclusion and distal embolization occur in 16%–18% of patients with stroke undergoing endovascular intervention. Only arterial reocclusion is associated with poor long-term outcome. Prospective studies are needed to identify risk factors for their occurrence and possible preventive therapies.
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