Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity

Sang Hwa Lee, Beom Joon Kim, Moon Ku Han, Tai Hwan Park, Kyung Bok Lee, Byung Chul Lee, Kyung Ho Yu, Mi Sun Oh, Jae Kwan Cha, Dae Hyun Kim, Hyun Wook Nah, Jun Lee, Soo Joo Lee, Jae Guk Kim, Jong Moo Park, Kyusik Kang, Yong Jin Cho, Keun Sik Hong, Hong Kyun Park, Jay Chol ChoiJoon Tae Kim, Kangho Choi, Dong Eog Kim, Wi Sun Ryu, Wook Joo Kim, Dong Ick Shin, Minju Yeo, Sung Il Sohn, Jeong Ho Hong, Juneyoung Lee, Ji Sung Lee, Pooja Khatri, Hee Joon Bae

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Abstract

Background: Futile reperfusion (poor functional status despite successful reperfusion) was observed in up to 67% of patients enrolled in recent endovascular treatment (EVT) clinical trials. We investigated the impact of baseline stroke severity on both futile reperfusion and therapeutic benefit of successful EVT. Methods: Using a prospective multicenter stroke registry, we identified consecutive ischemic stroke patients with anterior circulation large artery occlusion, who were reperfused successfully by EVT (Thrombolysis in Cerebral Infarction grade 2b-3). The rate of futile reperfusion was assessed across the initial National Institutes of Health Stroke Scale (NIHSS) scores. The frequency of poor outcomes (modified Rankin scale [mRS] 3-6) according to NIHSS scores was compared between patients revascularized successfully by EVT and those who did not receive EVT, after standardizing for age. Results: Among 21,591 patients with ischemic stroke, 972 (4.5%) received EVT within 12 h of onset, including 440 who met study eligibility criteria. Futile reperfusion was observed in 226 of the 440 study-eligible patients (51.4%) and was associated with stroke severity: 20.9% in NIHSS scores ≤5, 34.6% in 6-10, 58.9% in 11-20, and 63.8% in > 20 (p < 0.001). Nonetheless, the therapeutic benefit of EVT also increased with increasing stroke severity (p for interaction < 0.001): 0.1% in NIHSS ≤5, 18.6% in 6-10, 28.7% in 11-20, and 34.3% in > 20. Conclusions: EVT is more beneficial with increasing stroke severity, although futile reperfusion also increases with higher stroke severity.

Original languageEnglish
Article number11
JournalBMC Neurology
Volume19
Issue number1
DOIs
Publication statusPublished - 2019 Jan 15

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Keywords

  • Endovascular treatment
  • Futile reperfusion
  • Stroke severity
  • Therapeutic benefit

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Lee, S. H., Kim, B. J., Han, M. K., Park, T. H., Lee, K. B., Lee, B. C., Yu, K. H., Oh, M. S., Cha, J. K., Kim, D. H., Nah, H. W., Lee, J., Lee, S. J., Kim, J. G., Park, J. M., Kang, K., Cho, Y. J., Hong, K. S., Park, H. K., ... Bae, H. J. (2019). Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity. BMC Neurology, 19(1), [11]. https://doi.org/10.1186/s12883-019-1237-2