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

Cited 1 time in Web of Science Cited 2 time in Scopus
Authors
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
Issue Date
2019-01-15
Publisher
BioMed Central
Citation
BMC Neurology, 19(1):11
Keywords
Futile reperfusionEndovascular treatmentStroke severityTherapeutic benefit
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.
ISSN
1471-2377
Language
English
URI
http://hdl.handle.net/10371/147096
DOI
https://doi.org/10.1186/s12883-019-1237-2
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Neurology (신경과학교실)Journal Papers (저널논문_신경과학교실)
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