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 Choi & 13 others Joon 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

Research output: Contribution to journalArticle

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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Reperfusion
Stroke
National Institutes of Health (U.S.)
Therapeutics
Cerebral Infarction
Registries
Arteries
Clinical Trials

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity. / Lee, Sang Hwa; Kim, Beom Joon; Han, Moon Ku; Park, Tai Hwan; Lee, Kyung Bok; Lee, Byung Chul; Yu, Kyung Ho; Oh, Mi Sun; Cha, Jae Kwan; Kim, Dae Hyun; Nah, Hyun Wook; Lee, Jun; Lee, Soo Joo; Kim, Jae Guk; Park, Jong Moo; Kang, Kyusik; Cho, Yong Jin; Hong, Keun Sik; Park, Hong Kyun; Choi, Jay Chol; Kim, Joon Tae; Choi, Kangho; Kim, Dong Eog; Ryu, Wi Sun; Kim, Wook Joo; Shin, Dong Ick; Yeo, Minju; Sohn, Sung Il; Hong, Jeong Ho; Lee, Juneyoung; Lee, Ji Sung; Khatri, Pooja; Bae, Hee Joon.

In: BMC Neurology, Vol. 19, No. 1, 11, 15.01.2019.

Research output: Contribution to journalArticle

Lee, SH, Kim, BJ, Han, MK, Park, TH, Lee, KB, Lee, BC, Yu, KH, Oh, MS, Cha, JK, Kim, DH, Nah, HW, Lee, J, Lee, SJ, Kim, JG, Park, JM, Kang, K, Cho, YJ, Hong, KS, Park, HK, Choi, JC, Kim, JT, Choi, K, Kim, DE, Ryu, WS, Kim, WJ, Shin, DI, Yeo, M, Sohn, SI, Hong, JH, Lee, J, Lee, JS, Khatri, P & Bae, HJ 2019, 'Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity', BMC Neurology, vol. 19, no. 1, 11. https://doi.org/10.1186/s12883-019-1237-2
Lee, Sang Hwa ; Kim, Beom Joon ; Han, Moon Ku ; Park, Tai Hwan ; Lee, Kyung Bok ; Lee, Byung Chul ; Yu, Kyung Ho ; Oh, Mi Sun ; Cha, Jae Kwan ; Kim, Dae Hyun ; Nah, Hyun Wook ; Lee, Jun ; Lee, Soo Joo ; Kim, Jae Guk ; Park, Jong Moo ; Kang, Kyusik ; Cho, Yong Jin ; Hong, Keun Sik ; Park, Hong Kyun ; Choi, Jay Chol ; Kim, Joon Tae ; Choi, Kangho ; Kim, Dong Eog ; Ryu, Wi Sun ; Kim, Wook Joo ; Shin, Dong Ick ; Yeo, Minju ; Sohn, Sung Il ; Hong, Jeong Ho ; Lee, Juneyoung ; Lee, Ji Sung ; Khatri, Pooja ; Bae, Hee Joon. / Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity. In: BMC Neurology. 2019 ; Vol. 19, No. 1.
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author = "Lee, {Sang Hwa} and Kim, {Beom Joon} and Han, {Moon Ku} and Park, {Tai Hwan} 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 Nah, {Hyun Wook} and Jun Lee and Lee, {Soo Joo} and Kim, {Jae Guk} and Park, {Jong Moo} and Kyusik Kang and Cho, {Yong Jin} and Hong, {Keun Sik} and Park, {Hong Kyun} and Choi, {Jay Chol} and Kim, {Joon Tae} and Kangho Choi and Kim, {Dong Eog} and Ryu, {Wi Sun} and Kim, {Wook Joo} and Shin, {Dong Ick} and Minju Yeo and Sohn, {Sung Il} and Hong, {Jeong Ho} and Juneyoung Lee and Lee, {Ji Sung} and Pooja Khatri and Bae, {Hee Joon}",
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T1 - Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity

AU - Lee, Sang Hwa

AU - Kim, Beom Joon

AU - Han, Moon Ku

AU - Park, Tai Hwan

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 - Nah, Hyun Wook

AU - Lee, Jun

AU - Lee, Soo Joo

AU - Kim, Jae Guk

AU - Park, Jong Moo

AU - Kang, Kyusik

AU - Cho, Yong Jin

AU - Hong, Keun Sik

AU - Park, Hong Kyun

AU - Choi, Jay Chol

AU - Kim, Joon Tae

AU - Choi, Kangho

AU - Kim, Dong Eog

AU - Ryu, Wi Sun

AU - Kim, Wook Joo

AU - Shin, Dong Ick

AU - Yeo, Minju

AU - Sohn, Sung Il

AU - Hong, Jeong Ho

AU - Lee, Juneyoung

AU - Lee, Ji Sung

AU - Khatri, Pooja

AU - Bae, Hee Joon

PY - 2019/1/15

Y1 - 2019/1/15

N2 - 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.

AB - 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.

KW - Endovascular treatment

KW - Futile reperfusion

KW - Stroke severity

KW - Therapeutic benefit

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U2 - 10.1186/s12883-019-1237-2

DO - 10.1186/s12883-019-1237-2

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JO - BMC Neurology

JF - BMC Neurology

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