Multivariate analysis of futile recanalization after intravascular therapy in patients with acute anterior circulation occlusion

JI Yunpeng; LIU Yongxin; HE Shuang; ZHANG Yunfeng

doi:10.7619/jcmp.20232280

Journal of Clinical Medicine in Practice > 2023 > 27(22): 77-80, 85. > DOI: 10.7619/jcmp.20232280

JI Yunpeng, LIU Yongxin, HE Shuang, ZHANG Yunfeng. Multivariate analysis of futile recanalization after intravascular therapy in patients with acute anterior circulation occlusion[J]. Journal of Clinical Medicine in Practice, 2023, 27(22): 77-80, 85. DOI: 10.7619/jcmp.20232280

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Multivariate analysis of futile recanalization after intravascular therapy in patients with acute anterior circulation occlusion

Stroke Center and Department of Neurology, the Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226019

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Received Date: July 18, 2023
Revised Date: August 22, 2023
Available Online: December 05, 2023

Graphical Abstract

Abstract

Abstract

Objective
To explore the incidence and risk factors of futile recanalization after intravascular therapy in patients with acute anterior circulation occlusion.
Methods
Clinical materials of 176 patients with acute anterior circulation occlusion in the registration system of the Stroke Center of the Affiliated Hospital of Nantong University from August 2015 to December 2021 were retrospectively analyzed. All the patients received intravascular therapy to successfully achieve angiographic recanalization[grade of modified thrombolysis in cerebral infarction (mTICI) ≥ 2b], and were divided into futile recanalization group [score of modified Rankin Scale (mRS) was 3 to 6 points] and effective recanalization group (mRS score was 0 to 2 points) based on functional independence at 90 days after surgery. Logistic regression analysis was used to identify predictors of futile recanalization after intravascular treatment.
Results
In the 176 patients, 93 patients had futile recanalization, and 83 patients had effective recanalization. There were significant differences in age, gender, atrial fibrillation, score of the National Institute of Health Stroke Scale (NIHSS) on hospital admission, ischemic time, bridging treatment and hemorrhagic transformation between the futile recanalization group and the effective recanalization group (P < 0.05). Multivariate Logistic regression analysis showed that high NIHSS score on hospital admission (OR=0.815, 95%CI, 0.760 to 0.874, P < 0.001) and ischemic time (OR=1.232, 95%CI, 1.020 to 1.488, P=0.030) were the independent predictors of futile recanalization.
Conclusion
The incidence of futile recanalization after intravascular treatment is relatively high in patients with acute anterior circulation occlusion, while age, gender, atrial fibrillation, high NIHSS score on hospital admission, ischemic time, bridging treatment and hemorrhagic transformation are the risk factors for futile recanalization after intravascular treatment in AIS patients, and high NIHSS score on hospital admission and ischemic time are the independent predictive factors for futile recanalization after intravascular treatment in AIS patients.

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References

[1]	MA Q F, LI R, WANG L J, et al. Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the Global Burden of Disease Study 2019[J]. Lancet Public Health, 2021, 6(12): e897-e906. doi: 10.1016/S2468-2667(21)00228-0
[2]	GOYAL M, MENON B K, VAN ZWAM W H, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials[J]. Lancet, 2016, 387(10029): 1723-1731. doi: 10.1016/S0140-6736(16)00163-X
[3]	CAMPBELL B C V, MAJOIE C B L M, ALBERS G W, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data[J]. Lancet Neurol, 2019, 18(1): 46-55. doi: 10.1016/S1474-4422(18)30314-4
[4]	ZAIDAT O O, YOO A J, KHATRI P, et al. Cerebral Angiographic Revascularization Grading (CARG) Collaborators; STIR Revascularization working group; STIR Thrombolysis in Cerebral Infarction (TICI) Task Force. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement[J]. Stroke, 2013, 44(9): 2650-2663. doi: 10.1161/STROKEAHA.113.001972
[5]	HUSSEIN H M, SALEEM M A, QURESHI A I. Rates and predictors of futile recanalization in patients undergoing endovascular treatment in a multicenter clinical trial[J]. Neuroradiology, 2018, 60(5): 557-563. doi: 10.1007/s00234-018-2016-2
[6]	HASSAN A E, SHARIFF U, SAVER J L, et al. Impact of procedural time on clinical and angiographic outcomes in patients with acute ischemic stroke receiving endovascular treatment[J]. J Neurointerv Surg, 2019, 11(10): 984-988. doi: 10.1136/neurintsurg-2018-014576
[7]	VAN HORN N, KNIEP H, LEISCHNER H, et al. Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients[J]. J Neurointerv Surg, 2021, 13(1): 14-18. doi: 10.1136/neurintsurg-2020-015889
[8]	NOGUEIRA R G, JADHAV A P, HAUSSEN D C, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct[J]. N Engl J Med, 2018, 378(1): 11-21. doi: 10.1056/NEJMoa1706442
[9]	ALBERS G W, MARKS M P, KEMP S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging[J]. N Engl J Med, 2018, 378(8): 708-718. doi: 10.1056/NEJMoa1713973
[10]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004
[11]	PAN H, LIN C, CHEN L, et al. Multiple-Factor Analyses of Futile Recanalization in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy[J]. Front Neurol, 2021, 12: 704088. doi: 10.3389/fneur.2021.704088
[12]	郭四平, 杨丽慧, 董万利. 急性缺血性脑卒中患者预后相关危险因素分析[J]. 实用临床医药杂志, 2021, 25(7): 39-41, 46. doi: 10.7619/jcmp.20201527
[13]	JAHAN R, SAVER J L, SCHWAMM L H, et al. Association between time to treatment with endovascular reperfusion therapy and outcomes in patients with acute ischemic stroke treated in clinical practice[J]. JAMA, 2019, 322(3): 252. doi: 10.1001/jama.2019.8286
[14]	REZAI M, ADVANI R, DALEN I, et al. Endovascular thrombectomy in the elderly: do radiological and clinical outcomes differ from those in younger patients A prospective single-center experience[J]. Cerebrovasc Dis, 2019, 47(1/2): 65-71.
[15]	KAWABATA Y, NAKAJIMA N, MIYAKE H, et al. Endovascular treatment of acute ischaemic stroke in octogenarians and nonagenarians compared with younger patients[J]. Neuroradiol J, 2019, 32: 303-308. doi: 10.1177/1971400919840847
[16]	MEYER L, ALEXANDROU M, LEISCHNER H, et al. Mechanical thrombectomy in nonagenarians with acute ischemic stroke[J]. J Neurointerv Surg, 2019, 11(11): 1091-1094. doi: 10.1136/neurintsurg-2019-014785
[17]	DE RIDDER I R, FRANSEN P S S, BEUMER D, et al. Is intra-arterial treatment for acute ischemic stroke less effective in women than in men[J]. Interv Neurol, 2016, 5(3/4): 174-178.
[18]	ROCKMAN C, CASO V, SCHNEIDER P A. Carotid Interventions for Women: The Hazards and Benefits[J]. Stroke, 2022, 53(2): 611-623. doi: 10.1161/STROKEAHA.121.035386
[19]	WANG X G, ZHANG L Q, LIAO X L, et al. Unfavorable Outcome of Thrombolysis in Chinese Patients with Cardioembolic Stroke: a Prospective Cohort Study[J]. CNS Neurosci Ther, 2015, 21(8): 657-661. doi: 10.1111/cns.12421
[20]	YANG J H, WU Y F, GAO X, et al. Poor collateral flow with severe hypoperfusion explains worse outcome in acute stroke patients with atrial fibrillation[J]. Int J Stroke, 2023, 18(6): 689-696. doi: 10.1177/17474930221138707
[21]	MITCHELL P J, YAN B, CHURILOV L, et al. Endovascular thrombectomy versus standard bridging thrombolytic with endovascular thrombectomy within 4·5 h of stroke onset: an open-label, blinded-endpoint, randomised non-inferiority trial[J]. Lancet, 2022, 400(10346): 116-125. doi: 10.1016/S0140-6736(22)00564-5
[22]	SEBASTIAN B, RALPH W, TOMAS D, et al. Direct mechanical intervention versus bridging therapy in stroke patients eligible for intravenous thrombolysis: a pooled analysis of 2 registries[J]. Stroke, 2017, 48(12): 3282-3288. doi: 10.1161/STROKEAHA.117.018459
[23]	YAGHI S, BOEHME A K, DIBU J, et al. Treatment and Outcome of Thrombolysis-Related Hemorrhage: A Multicenter Retrospective Study[J]. JAMA Neurol, 2015, 72(12): 1451-1457. doi: 10.1001/jamaneurol.2015.2371
[24]	VAN KRANENDONK K R, TREURNIET K M, BOERS A M M, et al. Hemorrhagic transformation is associated with poor functional outcome in patients with acute ischemic stroke due to a large vessel occlusion[J]. J Neurointerv Surg, 2019, 11(5): 464-468. doi: 10.1136/neurintsurg-2018-014141
[25]	OLIVOT J M, FINITSIS S, LAPERGUE B, et al. Parenchymal hemorrhage rate is associated with time to reperfusion and outcome[J]. Ann Neurol, 2022, 92(5): 882-887. doi: 10.1002/ana.26478

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