Endovascular Treatment in Patients with Persistent Internal Carotid Artery Occlusion after Intravenous Tissue Plasminogen Activator: A Clinical Effectiveness Study

Jeong Ho Hong, Sung Il Sohn, Jihoon Kang, Min Uk Jang, Beom Joon Kim, Moon Ku Han, Tai Hwan Park, Sang Soon Park, Kyung Bok Lee, Byung Chul Lee, Kyung Ho Yu, Mi Sun Oh, Jae Kwan Cha, Dae Hyun Kim, Jun Lee, Soo Joo Lee, Youngchai Ko, Jae Guk Kim, Jong Moo Park, Kyusik KangYong Jin Cho, Keun Sik Hong, Ki Hyun Cho, Joon Tae Kim, Jay Chol Choi, Juneyoung Lee, Ji Sung Lee, Philip B. Gorelick, Hee Joon Bae

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: There has been no large-scale trial comparing endovascular treatment (add-on EVT) after intravenous tissue plasminogen activator (IV tPA) and IV tPA alone in acute ischemic stroke (AIS) caused by internal carotid artery occlusion (ICAO). We aimed at investigating the effectiveness and safety of add-on EVT after IV tPA in AIS patients with ICAO. Methods: Between March 2010 and March 2013, 3,689 consecutive ischemic stroke patients who were hospitalized within 4.5 h of onset were identified using a prospective stroke registry at 11 centers in Korea. Among them, patients with persistent ICAO after receiving IV tPA and whose 3-month modified Rankin Scale (mRS) was available were finally enrolled. A propensity score analysis with inverse-probability of treatment weighting was used to eliminate baseline imbalances between those receiving add-on EVT and IV tPA alone. Results: Among 264 patients enrolled in this study (mean age 71.4; male 56.4%; median National Institute of Health Stroke Scale score 15), 117 (44.3%) received add-on EVT. The add-on EVT group had a higher frequency of favorable outcome on the mRS ≤2 (35.0 vs. 18.4%; adjusted OR (aOR) 2.79; 95% CI 1.66-4.67) and lower mortality (17.9 vs. 35.4%; aOR 0.24; 95% CI 0.13-0.42) at 3 months, when compared to the IV tPA-alone group. Add-on EVT did not significantly increase the risk of symptomatic hemorrhage (5.1 vs. 4.1%; aOR 1.01; 95% CI 0.37-2.70). The rate of successful recanalization (thrombolysis in cerebral infarction grade ≥2b) in the add-on EVT group was 69.2%. Conclusions: Compared to an IV tPA alone, add-on EVT can improve clinical outcomes in patients with symptomatic ICAO within 4.5 h of onset without a significant increase of symptomatic hemorrhage.

Original languageEnglish
Pages (from-to)387-394
Number of pages8
JournalCerebrovascular Diseases
Volume42
Issue number5-6
DOIs
Publication statusPublished - 2016 Nov 1

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Internal Carotid Artery
Tissue Plasminogen Activator
Stroke
Therapeutics
Hemorrhage
Propensity Score
Cerebral Infarction
National Institutes of Health (U.S.)
Korea
Clinical Studies
Registries
Safety
Mortality

Keywords

  • Acute stroke
  • Acute stroke intervention
  • Carotid arteries
  • Endovascular revascularization
  • Revascularization
  • Thrombolysis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Endovascular Treatment in Patients with Persistent Internal Carotid Artery Occlusion after Intravenous Tissue Plasminogen Activator : A Clinical Effectiveness Study. / Hong, Jeong Ho; Sohn, Sung Il; Kang, Jihoon; Jang, Min Uk; Kim, Beom Joon; Han, Moon Ku; Park, Tai Hwan; Park, Sang Soon; Lee, Kyung Bok; Lee, Byung Chul; Yu, Kyung Ho; Oh, Mi Sun; Cha, Jae Kwan; Kim, Dae Hyun; Lee, Jun; Lee, Soo Joo; Ko, Youngchai; Kim, Jae Guk; Park, Jong Moo; Kang, Kyusik; Cho, Yong Jin; Hong, Keun Sik; Cho, Ki Hyun; Kim, Joon Tae; Choi, Jay Chol; Lee, Juneyoung; Lee, Ji Sung; Gorelick, Philip B.; Bae, Hee Joon.

In: Cerebrovascular Diseases, Vol. 42, No. 5-6, 01.11.2016, p. 387-394.

Research output: Contribution to journalArticle

Hong, JH, Sohn, SI, Kang, J, Jang, MU, Kim, BJ, Han, MK, Park, TH, Park, SS, Lee, KB, Lee, BC, Yu, KH, Oh, MS, Cha, JK, Kim, DH, Lee, J, Lee, SJ, Ko, Y, Kim, JG, Park, JM, Kang, K, Cho, YJ, Hong, KS, Cho, KH, Kim, JT, Choi, JC, Lee, J, Lee, JS, Gorelick, PB & Bae, HJ 2016, 'Endovascular Treatment in Patients with Persistent Internal Carotid Artery Occlusion after Intravenous Tissue Plasminogen Activator: A Clinical Effectiveness Study', Cerebrovascular Diseases, vol. 42, no. 5-6, pp. 387-394. https://doi.org/10.1159/000447599
Hong, Jeong Ho ; Sohn, Sung Il ; Kang, Jihoon ; Jang, Min Uk ; Kim, Beom Joon ; Han, Moon Ku ; Park, Tai Hwan ; Park, Sang Soon ; Lee, Kyung Bok ; Lee, Byung Chul ; Yu, Kyung Ho ; Oh, Mi Sun ; Cha, Jae Kwan ; Kim, Dae Hyun ; Lee, Jun ; Lee, Soo Joo ; Ko, Youngchai ; Kim, Jae Guk ; Park, Jong Moo ; Kang, Kyusik ; Cho, Yong Jin ; Hong, Keun Sik ; Cho, Ki Hyun ; Kim, Joon Tae ; Choi, Jay Chol ; Lee, Juneyoung ; Lee, Ji Sung ; Gorelick, Philip B. ; Bae, Hee Joon. / Endovascular Treatment in Patients with Persistent Internal Carotid Artery Occlusion after Intravenous Tissue Plasminogen Activator : A Clinical Effectiveness Study. In: Cerebrovascular Diseases. 2016 ; Vol. 42, No. 5-6. pp. 387-394.
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abstract = "Background: There has been no large-scale trial comparing endovascular treatment (add-on EVT) after intravenous tissue plasminogen activator (IV tPA) and IV tPA alone in acute ischemic stroke (AIS) caused by internal carotid artery occlusion (ICAO). We aimed at investigating the effectiveness and safety of add-on EVT after IV tPA in AIS patients with ICAO. Methods: Between March 2010 and March 2013, 3,689 consecutive ischemic stroke patients who were hospitalized within 4.5 h of onset were identified using a prospective stroke registry at 11 centers in Korea. Among them, patients with persistent ICAO after receiving IV tPA and whose 3-month modified Rankin Scale (mRS) was available were finally enrolled. A propensity score analysis with inverse-probability of treatment weighting was used to eliminate baseline imbalances between those receiving add-on EVT and IV tPA alone. Results: Among 264 patients enrolled in this study (mean age 71.4; male 56.4{\%}; median National Institute of Health Stroke Scale score 15), 117 (44.3{\%}) received add-on EVT. The add-on EVT group had a higher frequency of favorable outcome on the mRS ≤2 (35.0 vs. 18.4{\%}; adjusted OR (aOR) 2.79; 95{\%} CI 1.66-4.67) and lower mortality (17.9 vs. 35.4{\%}; aOR 0.24; 95{\%} CI 0.13-0.42) at 3 months, when compared to the IV tPA-alone group. Add-on EVT did not significantly increase the risk of symptomatic hemorrhage (5.1 vs. 4.1{\%}; aOR 1.01; 95{\%} CI 0.37-2.70). The rate of successful recanalization (thrombolysis in cerebral infarction grade ≥2b) in the add-on EVT group was 69.2{\%}. Conclusions: Compared to an IV tPA alone, add-on EVT can improve clinical outcomes in patients with symptomatic ICAO within 4.5 h of onset without a significant increase of symptomatic hemorrhage.",
keywords = "Acute stroke, Acute stroke intervention, Carotid arteries, Endovascular revascularization, Revascularization, Thrombolysis",
author = "Hong, {Jeong Ho} and Sohn, {Sung Il} and Jihoon Kang and Jang, {Min Uk} and Kim, {Beom Joon} and Han, {Moon Ku} and Park, {Tai Hwan} and Park, {Sang Soon} and Lee, {Kyung Bok} and Lee, {Byung Chul} and Yu, {Kyung Ho} and Oh, {Mi Sun} and Cha, {Jae Kwan} and Kim, {Dae Hyun} and Jun Lee and Lee, {Soo Joo} and Youngchai Ko and Kim, {Jae Guk} and Park, {Jong Moo} and Kyusik Kang and Cho, {Yong Jin} and Hong, {Keun Sik} and Cho, {Ki Hyun} and Kim, {Joon Tae} and Choi, {Jay Chol} and Juneyoung Lee and Lee, {Ji Sung} and Gorelick, {Philip B.} and Bae, {Hee Joon}",
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TY - JOUR

T1 - Endovascular Treatment in Patients with Persistent Internal Carotid Artery Occlusion after Intravenous Tissue Plasminogen Activator

T2 - A Clinical Effectiveness Study

AU - Hong, Jeong Ho

AU - Sohn, Sung Il

AU - Kang, Jihoon

AU - Jang, Min Uk

AU - Kim, Beom Joon

AU - Han, Moon Ku

AU - Park, Tai Hwan

AU - Park, Sang Soon

AU - Lee, Kyung Bok

AU - Lee, Byung Chul

AU - Yu, Kyung Ho

AU - Oh, Mi Sun

AU - Cha, Jae Kwan

AU - Kim, Dae Hyun

AU - Lee, Jun

AU - Lee, Soo Joo

AU - Ko, Youngchai

AU - Kim, Jae Guk

AU - Park, Jong Moo

AU - Kang, Kyusik

AU - Cho, Yong Jin

AU - Hong, Keun Sik

AU - Cho, Ki Hyun

AU - Kim, Joon Tae

AU - Choi, Jay Chol

AU - Lee, Juneyoung

AU - Lee, Ji Sung

AU - Gorelick, Philip B.

AU - Bae, Hee Joon

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background: There has been no large-scale trial comparing endovascular treatment (add-on EVT) after intravenous tissue plasminogen activator (IV tPA) and IV tPA alone in acute ischemic stroke (AIS) caused by internal carotid artery occlusion (ICAO). We aimed at investigating the effectiveness and safety of add-on EVT after IV tPA in AIS patients with ICAO. Methods: Between March 2010 and March 2013, 3,689 consecutive ischemic stroke patients who were hospitalized within 4.5 h of onset were identified using a prospective stroke registry at 11 centers in Korea. Among them, patients with persistent ICAO after receiving IV tPA and whose 3-month modified Rankin Scale (mRS) was available were finally enrolled. A propensity score analysis with inverse-probability of treatment weighting was used to eliminate baseline imbalances between those receiving add-on EVT and IV tPA alone. Results: Among 264 patients enrolled in this study (mean age 71.4; male 56.4%; median National Institute of Health Stroke Scale score 15), 117 (44.3%) received add-on EVT. The add-on EVT group had a higher frequency of favorable outcome on the mRS ≤2 (35.0 vs. 18.4%; adjusted OR (aOR) 2.79; 95% CI 1.66-4.67) and lower mortality (17.9 vs. 35.4%; aOR 0.24; 95% CI 0.13-0.42) at 3 months, when compared to the IV tPA-alone group. Add-on EVT did not significantly increase the risk of symptomatic hemorrhage (5.1 vs. 4.1%; aOR 1.01; 95% CI 0.37-2.70). The rate of successful recanalization (thrombolysis in cerebral infarction grade ≥2b) in the add-on EVT group was 69.2%. Conclusions: Compared to an IV tPA alone, add-on EVT can improve clinical outcomes in patients with symptomatic ICAO within 4.5 h of onset without a significant increase of symptomatic hemorrhage.

AB - Background: There has been no large-scale trial comparing endovascular treatment (add-on EVT) after intravenous tissue plasminogen activator (IV tPA) and IV tPA alone in acute ischemic stroke (AIS) caused by internal carotid artery occlusion (ICAO). We aimed at investigating the effectiveness and safety of add-on EVT after IV tPA in AIS patients with ICAO. Methods: Between March 2010 and March 2013, 3,689 consecutive ischemic stroke patients who were hospitalized within 4.5 h of onset were identified using a prospective stroke registry at 11 centers in Korea. Among them, patients with persistent ICAO after receiving IV tPA and whose 3-month modified Rankin Scale (mRS) was available were finally enrolled. A propensity score analysis with inverse-probability of treatment weighting was used to eliminate baseline imbalances between those receiving add-on EVT and IV tPA alone. Results: Among 264 patients enrolled in this study (mean age 71.4; male 56.4%; median National Institute of Health Stroke Scale score 15), 117 (44.3%) received add-on EVT. The add-on EVT group had a higher frequency of favorable outcome on the mRS ≤2 (35.0 vs. 18.4%; adjusted OR (aOR) 2.79; 95% CI 1.66-4.67) and lower mortality (17.9 vs. 35.4%; aOR 0.24; 95% CI 0.13-0.42) at 3 months, when compared to the IV tPA-alone group. Add-on EVT did not significantly increase the risk of symptomatic hemorrhage (5.1 vs. 4.1%; aOR 1.01; 95% CI 0.37-2.70). The rate of successful recanalization (thrombolysis in cerebral infarction grade ≥2b) in the add-on EVT group was 69.2%. Conclusions: Compared to an IV tPA alone, add-on EVT can improve clinical outcomes in patients with symptomatic ICAO within 4.5 h of onset without a significant increase of symptomatic hemorrhage.

KW - Acute stroke

KW - Acute stroke intervention

KW - Carotid arteries

KW - Endovascular revascularization

KW - Revascularization

KW - Thrombolysis

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