Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke

Jeong Ho Hong, 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, Jong Moo Park, Kyusik Kang, Yong Jin Cho, Keun Sik Hong & 5 others Ki Hyun Cho, Joon Tae Kim, Juneyoung Lee, Ji Sung Lee, Hee Joon Bae

Research output: Contribution to journalArticle

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Abstract

Background We aimed to describe the current status and clinical outcomes of recanalization therapy for internal carotid artery occlusion (ICAO) presenting as acute ischemic stroke.

Methods Using a nationwide stroke registry database in Korea, we identified consecutive ischemic stroke patients with ICAO hospitalized within 12 hours of onset between March 2010 and November 2011.

Results ICAO accounted for 10.6% (322 of 3028) of acute ischemic strokes within 12 hours of onset. Among the 322 ICAO patients, 53% underwent recanalization therapy, 41% intravenous thrombolysis (IVT) alone, and 59% endovascular treatment (EVT). Twenty-two percent of those with mild deficits (National Institutes of Health Stroke Scale <4) and 50% of those 80 years of age or more received recanalization therapy. Compared with no treatment, recanalization therapy was not significantly associated with a favorable outcome (3-month modified Rankin scale, 0-2) (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI],.80-3.91; P =.16). However, compared with IVT, EVT significantly improved the odds of favorable outcome (OR, 2.86; 95% CI, 1.19-6.88; P =.02) without significant increase of symptomatic intracranial hemorrhage (OR, 2.18; 95% CI,.42-11.43; P =.36) and 3-month mortality (OR,.53; 95% CI,.23-1.18; P =.12). Successful recanalization rate (Thrombolysis in Cerebral Infarction <2a) by EVT was 76%.

Conclusions In Korea, one tenth of acute ischemic stroke was caused by ICAO, and about 50% were treated by recanalization therapy. EVT was widely used as a recanalization modality (about 60% of cases) despite lack of evidence. However, its effectiveness and safety were acceptable.

Original languageEnglish
Pages (from-to)2183-2189
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume23
Issue number8
DOIs
Publication statusPublished - 2014 Jan 1

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Internal Carotid Artery
Stroke
Odds Ratio
Confidence Intervals
Therapeutics
Korea
Intracranial Hemorrhages
Cerebral Infarction
National Institutes of Health (U.S.)
Registries
Databases
Safety
Mortality

Keywords

  • acute stroke
  • carotid artery
  • Endovascular recanalization
  • revascularization
  • thrombolysis

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke. / Hong, Jeong Ho; 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; Park, Jong Moo; Kang, Kyusik; Cho, Yong Jin; Hong, Keun Sik; Cho, Ki Hyun; Kim, Joon Tae; Lee, Juneyoung; Lee, Ji Sung; Bae, Hee Joon.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 23, No. 8, 01.01.2014, p. 2183-2189.

Research output: Contribution to journalArticle

Hong, JH, 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, Park, JM, Kang, K, Cho, YJ, Hong, KS, Cho, KH, Kim, JT, Lee, J, Lee, JS & Bae, HJ 2014, 'Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke', Journal of Stroke and Cerebrovascular Diseases, vol. 23, no. 8, pp. 2183-2189. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.04.025
Hong, Jeong Ho ; 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 ; Park, Jong Moo ; Kang, Kyusik ; Cho, Yong Jin ; Hong, Keun Sik ; Cho, Ki Hyun ; Kim, Joon Tae ; Lee, Juneyoung ; Lee, Ji Sung ; Bae, Hee Joon. / Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke. In: Journal of Stroke and Cerebrovascular Diseases. 2014 ; Vol. 23, No. 8. pp. 2183-2189.
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abstract = "Background We aimed to describe the current status and clinical outcomes of recanalization therapy for internal carotid artery occlusion (ICAO) presenting as acute ischemic stroke.Methods Using a nationwide stroke registry database in Korea, we identified consecutive ischemic stroke patients with ICAO hospitalized within 12 hours of onset between March 2010 and November 2011.Results ICAO accounted for 10.6{\%} (322 of 3028) of acute ischemic strokes within 12 hours of onset. Among the 322 ICAO patients, 53{\%} underwent recanalization therapy, 41{\%} intravenous thrombolysis (IVT) alone, and 59{\%} endovascular treatment (EVT). Twenty-two percent of those with mild deficits (National Institutes of Health Stroke Scale <4) and 50{\%} of those 80 years of age or more received recanalization therapy. Compared with no treatment, recanalization therapy was not significantly associated with a favorable outcome (3-month modified Rankin scale, 0-2) (adjusted odds ratio [OR], 1.77; 95{\%} confidence interval [CI],.80-3.91; P =.16). However, compared with IVT, EVT significantly improved the odds of favorable outcome (OR, 2.86; 95{\%} CI, 1.19-6.88; P =.02) without significant increase of symptomatic intracranial hemorrhage (OR, 2.18; 95{\%} CI,.42-11.43; P =.36) and 3-month mortality (OR,.53; 95{\%} CI,.23-1.18; P =.12). Successful recanalization rate (Thrombolysis in Cerebral Infarction <2a) by EVT was 76{\%}.Conclusions In Korea, one tenth of acute ischemic stroke was caused by ICAO, and about 50{\%} were treated by recanalization therapy. EVT was widely used as a recanalization modality (about 60{\%} of cases) despite lack of evidence. However, its effectiveness and safety were acceptable.",
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T1 - Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke

AU - Hong, Jeong Ho

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 - Park, Jong Moo

AU - Kang, Kyusik

AU - Cho, Yong Jin

AU - Hong, Keun Sik

AU - Cho, Ki Hyun

AU - Kim, Joon Tae

AU - Lee, Juneyoung

AU - Lee, Ji Sung

AU - Bae, Hee Joon

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background We aimed to describe the current status and clinical outcomes of recanalization therapy for internal carotid artery occlusion (ICAO) presenting as acute ischemic stroke.Methods Using a nationwide stroke registry database in Korea, we identified consecutive ischemic stroke patients with ICAO hospitalized within 12 hours of onset between March 2010 and November 2011.Results ICAO accounted for 10.6% (322 of 3028) of acute ischemic strokes within 12 hours of onset. Among the 322 ICAO patients, 53% underwent recanalization therapy, 41% intravenous thrombolysis (IVT) alone, and 59% endovascular treatment (EVT). Twenty-two percent of those with mild deficits (National Institutes of Health Stroke Scale <4) and 50% of those 80 years of age or more received recanalization therapy. Compared with no treatment, recanalization therapy was not significantly associated with a favorable outcome (3-month modified Rankin scale, 0-2) (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI],.80-3.91; P =.16). However, compared with IVT, EVT significantly improved the odds of favorable outcome (OR, 2.86; 95% CI, 1.19-6.88; P =.02) without significant increase of symptomatic intracranial hemorrhage (OR, 2.18; 95% CI,.42-11.43; P =.36) and 3-month mortality (OR,.53; 95% CI,.23-1.18; P =.12). Successful recanalization rate (Thrombolysis in Cerebral Infarction <2a) by EVT was 76%.Conclusions In Korea, one tenth of acute ischemic stroke was caused by ICAO, and about 50% were treated by recanalization therapy. EVT was widely used as a recanalization modality (about 60% of cases) despite lack of evidence. However, its effectiveness and safety were acceptable.

AB - Background We aimed to describe the current status and clinical outcomes of recanalization therapy for internal carotid artery occlusion (ICAO) presenting as acute ischemic stroke.Methods Using a nationwide stroke registry database in Korea, we identified consecutive ischemic stroke patients with ICAO hospitalized within 12 hours of onset between March 2010 and November 2011.Results ICAO accounted for 10.6% (322 of 3028) of acute ischemic strokes within 12 hours of onset. Among the 322 ICAO patients, 53% underwent recanalization therapy, 41% intravenous thrombolysis (IVT) alone, and 59% endovascular treatment (EVT). Twenty-two percent of those with mild deficits (National Institutes of Health Stroke Scale <4) and 50% of those 80 years of age or more received recanalization therapy. Compared with no treatment, recanalization therapy was not significantly associated with a favorable outcome (3-month modified Rankin scale, 0-2) (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI],.80-3.91; P =.16). However, compared with IVT, EVT significantly improved the odds of favorable outcome (OR, 2.86; 95% CI, 1.19-6.88; P =.02) without significant increase of symptomatic intracranial hemorrhage (OR, 2.18; 95% CI,.42-11.43; P =.36) and 3-month mortality (OR,.53; 95% CI,.23-1.18; P =.12). Successful recanalization rate (Thrombolysis in Cerebral Infarction <2a) by EVT was 76%.Conclusions In Korea, one tenth of acute ischemic stroke was caused by ICAO, and about 50% were treated by recanalization therapy. EVT was widely used as a recanalization modality (about 60% of cases) despite lack of evidence. However, its effectiveness and safety were acceptable.

KW - acute stroke

KW - carotid artery

KW - Endovascular recanalization

KW - revascularization

KW - thrombolysis

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