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Neuroradiology

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01-05-2018 | Interventional Neuroradiology

Rates and predictors of futile recanalization in patients undergoing endovascular treatment in a multicenter clinical trial

Authors: Haitham M. Hussein, Muhammad A. Saleem, Adnan I. Qureshi

Published in: Neuroradiology | Issue 5/2018

Abstract

Purpose

The phenomenon of futile recanalization, defined as lack of clinical benefit despite angiographic recanalization, is an important limitation of endovascular treatment for acute ischemic stroke. We aim to characterize the occurrence and predictors of futile recanalization in the endovascular arm of the Interventional Management of Stroke (IMS) III trial.

Methods

Patients with near complete or complete recanalization (TICI grades 2b and 3) were divided according to functional outcome at 3 months into “meaningful recanalization,” defined as mRS score 0–2, and “futile recanalization,” mRS score 3–6. Multivariate analysis was performed to identify predictors of futile recanalization.

Results

Futile recanalization was observed in 61 (47%) of 130. Compared to meaningful recanalization group, the futile recanalization group had higher proportion of women (62.3 vs. 43.5%; p = 0.032), higher incidence of diabetes mellitus (29.5 vs. 8.7%; p = 0.004) and coronary artery disease (27.9 vs. 13%; p = 0.05), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (median [range] 19 [11–31] vs. 15 [8–26], p < 0.001), higher baseline serum glucose (7.6 ± 2.6 vs. 6.7 ± 1.7 mmol/L; p = 0.039), and longer onset-to-start of endovascular treatment time (265.8 ± 48.3 vs. 239.2 ± 47.7 min; p = 0.007). In multivariate analysis, NIHSS (OR 1.3; 95% CI 1.1–1.4), female gender (OR 3.0; 95% CI 1.1–8.2), and onset-to-start of endovascular treatment time (OR 1.2; 95% CI 1.1–1.3) were independent predictors of futile recanalization.

Conclusion

In IMS III, futile recanalization was common. Delay in endovascular treatment is the only modifiable risk factor. Additional strategies for non-modifiable risk factors—female gender and high NIHSS—need to be identified.

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Title: Rates and predictors of futile recanalization in patients undergoing endovascular treatment in a multicenter clinical trial
Authors: Haitham M. Hussein
Muhammad A. Saleem
Adnan I. Qureshi
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 5/2018
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-018-2016-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Rates and predictors of futile recanalization in patients undergoing endovascular treatment in a multicenter clinical trial

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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