Meta-Analysis

. 2016 Feb 23;86(8):762-70.

doi: 10.1212/WNL.0000000000002399. Epub 2016 Jan 22.

Effect of endovascular reperfusion in relation to site of arterial occlusion

Robin Lemmens¹, Scott A Hamilton², David S Liebeskind², Tom A Tomsick², Andrew M Demchuk², Raul G Nogueira², Michael P Marks², Reza Jahan², Jan Gralla², Albert J Yoo², Sharon D Yeatts², Yuko Y Palesch², Jeffrey L Saver², Vitor M Pereira², Joseph P Broderick², Gregory W Albers², Maarten G Lansberg²; DEFUSE 2, IMS III, STAR, and SWIFT trialists; DEFUSE 2 IMS III STAR and SWIFT trialists

Collaborators, Affiliations

Collaborators

Scott A Hamilton, Michael P Marks, Gregory W Albers, Maarten G Lansberg, David S Liebeskind, Tom A Tomsick, Andrew M Demchuck, Sharon D Yeatts, Yuko Y Palesch, Joseph P Broderick, Raul G Nogueira, David S Liebeskind, Jan Gralla, Vitor M Pereira, Raul G Nogueira, David S Liebeskind, Reza Jahan, Raul G Nogueira, Jeffrey L Saver

Affiliations

¹ From KU Leuven, University of Leuven, Belgium, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (R.L.); University Hospitals Leuven, Department of Neurology (R.L.); VIB, Vesalius Research Center, Laboratory of Neurobiology (R.L.); Stanford Stroke Center (S.A.H., M.P.M., G.W.A., M.G.L.), Stanford University of Medicine, CA; Neurovascular Imaging Research Core and Department of Neurology and Comprehensive Stroke Center (D.S.L., J.L.S.), and Division of Interventional Neuroradiology, Department of Radiology, David Geffen School of Medicine (R.J.), University of California, Los Angeles; Departments of Radiology (T.A.T.) and Neurology (J.P.B.), University of Cincinnati Medical Center, OH; Departments of Clinical Neurosciences and Radiology (A.M.D.), Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Canada; Departments of Neurology, Neurosurgery, and Radiology (R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA; Department of Diagnostic and Interventional Neuroradiology (J.G.), University Hospital Bern, Switzerland; Division of Diagnostic and Interventional Neuroradiology (A.J.Y.), Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Public Health Sciences (S.D.Y., Y.Y.P.), Medical University of South Carolina, Charleston; and Division of Neuroradiology, Department of Medical Imaging, and Division of Neurosurgery, Department of Surgery (V.M.P.), Toronto Western Hospital, University Health Network, Canada. robin.lemmens@uzleuven.be.
² From KU Leuven, University of Leuven, Belgium, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (R.L.); University Hospitals Leuven, Department of Neurology (R.L.); VIB, Vesalius Research Center, Laboratory of Neurobiology (R.L.); Stanford Stroke Center (S.A.H., M.P.M., G.W.A., M.G.L.), Stanford University of Medicine, CA; Neurovascular Imaging Research Core and Department of Neurology and Comprehensive Stroke Center (D.S.L., J.L.S.), and Division of Interventional Neuroradiology, Department of Radiology, David Geffen School of Medicine (R.J.), University of California, Los Angeles; Departments of Radiology (T.A.T.) and Neurology (J.P.B.), University of Cincinnati Medical Center, OH; Departments of Clinical Neurosciences and Radiology (A.M.D.), Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Canada; Departments of Neurology, Neurosurgery, and Radiology (R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA; Department of Diagnostic and Interventional Neuroradiology (J.G.), University Hospital Bern, Switzerland; Division of Diagnostic and Interventional Neuroradiology (A.J.Y.), Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Public Health Sciences (S.D.Y., Y.Y.P.), Medical University of South Carolina, Charleston; and Division of Neuroradiology, Department of Medical Imaging, and Division of Neurosurgery, Department of Surgery (V.M.P.), Toronto Western Hospital, University Health Network, Canada.

PMID: 26802090
PMCID: PMC4763803
DOI: 10.1212/WNL.0000000000002399

Meta-Analysis

Effect of endovascular reperfusion in relation to site of arterial occlusion

Robin Lemmens et al. Neurology. 2016.

. 2016 Feb 23;86(8):762-70.

doi: 10.1212/WNL.0000000000002399. Epub 2016 Jan 22.

Authors

Collaborators

Scott A Hamilton, Michael P Marks, Gregory W Albers, Maarten G Lansberg, David S Liebeskind, Tom A Tomsick, Andrew M Demchuck, Sharon D Yeatts, Yuko Y Palesch, Joseph P Broderick, Raul G Nogueira, David S Liebeskind, Jan Gralla, Vitor M Pereira, Raul G Nogueira, David S Liebeskind, Reza Jahan, Raul G Nogueira, Jeffrey L Saver

Affiliations

¹ From KU Leuven, University of Leuven, Belgium, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (R.L.); University Hospitals Leuven, Department of Neurology (R.L.); VIB, Vesalius Research Center, Laboratory of Neurobiology (R.L.); Stanford Stroke Center (S.A.H., M.P.M., G.W.A., M.G.L.), Stanford University of Medicine, CA; Neurovascular Imaging Research Core and Department of Neurology and Comprehensive Stroke Center (D.S.L., J.L.S.), and Division of Interventional Neuroradiology, Department of Radiology, David Geffen School of Medicine (R.J.), University of California, Los Angeles; Departments of Radiology (T.A.T.) and Neurology (J.P.B.), University of Cincinnati Medical Center, OH; Departments of Clinical Neurosciences and Radiology (A.M.D.), Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Canada; Departments of Neurology, Neurosurgery, and Radiology (R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA; Department of Diagnostic and Interventional Neuroradiology (J.G.), University Hospital Bern, Switzerland; Division of Diagnostic and Interventional Neuroradiology (A.J.Y.), Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Public Health Sciences (S.D.Y., Y.Y.P.), Medical University of South Carolina, Charleston; and Division of Neuroradiology, Department of Medical Imaging, and Division of Neurosurgery, Department of Surgery (V.M.P.), Toronto Western Hospital, University Health Network, Canada. robin.lemmens@uzleuven.be.
² From KU Leuven, University of Leuven, Belgium, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (R.L.); University Hospitals Leuven, Department of Neurology (R.L.); VIB, Vesalius Research Center, Laboratory of Neurobiology (R.L.); Stanford Stroke Center (S.A.H., M.P.M., G.W.A., M.G.L.), Stanford University of Medicine, CA; Neurovascular Imaging Research Core and Department of Neurology and Comprehensive Stroke Center (D.S.L., J.L.S.), and Division of Interventional Neuroradiology, Department of Radiology, David Geffen School of Medicine (R.J.), University of California, Los Angeles; Departments of Radiology (T.A.T.) and Neurology (J.P.B.), University of Cincinnati Medical Center, OH; Departments of Clinical Neurosciences and Radiology (A.M.D.), Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Canada; Departments of Neurology, Neurosurgery, and Radiology (R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA; Department of Diagnostic and Interventional Neuroradiology (J.G.), University Hospital Bern, Switzerland; Division of Diagnostic and Interventional Neuroradiology (A.J.Y.), Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Public Health Sciences (S.D.Y., Y.Y.P.), Medical University of South Carolina, Charleston; and Division of Neuroradiology, Department of Medical Imaging, and Division of Neurosurgery, Department of Surgery (V.M.P.), Toronto Western Hospital, University Health Network, Canada.

PMID: 26802090
PMCID: PMC4763803
DOI: 10.1212/WNL.0000000000002399

Abstract

Objective: To assess whether the association between reperfusion and improved clinical outcomes after stroke differs depending on the site of the arterial occlusive lesion (AOL).

Methods: We pooled data from Solitaire With the Intention for Thrombectomy (SWIFT), Solitaire FR Thrombectomy for Acute Revascularisation (STAR), Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2 (DEFUSE 2), and Interventional Management of Stroke Trial (IMS III) to compare the strength of the associations between reperfusion and clinical outcomes in patients with internal carotid artery (ICA), proximal middle cerebral artery (MCA) (M1), and distal MCA (M2/3/4) occlusions.

Results: Among 710 included patients, the site of the AOL was the ICA in 161, the proximal MCA in 389, and the distal MCA in 160 patients (M2 = 131, M3 = 23, and M4 = 6). Reperfusion was associated with an increase in the rate of good functional outcome (modified Rankin Scale [mRS] score 0-2) in patients with ICA (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.7-7.2) and proximal MCA occlusions (OR 6.2, 95% CI 3.8-10.2), but not in patients with distal MCA occlusions (OR 1.4, 95% CI 0.8-2.6). Among patients with M2 occlusions, a subset of the distal MCA cohort, reperfusion was associated with excellent functional outcome (mRS 0-1; OR 2.2, 95% CI 1.0-4.7).

Conclusions: The association between endovascular reperfusion and better clinical outcomes is more profound in patients with ICA and proximal MCA occlusions compared to patients with distal MCA occlusions. Because there are limited data from randomized controlled trials on the effect of endovascular therapy in patients with distal MCA occlusions, these results underscore the need for inclusion of this subgroup in future endovascular therapy trials.

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Figures

**Figure 1. Associations between reperfusion and clinical outcomes stratified by arterial occlusive lesion**
Graphs show the odds ratios for the associations between reperfusion and good functional outcome defined as modified Rankin Scale (mRS) score of 0–2 (A), excellent functional outcome defined as mRS of 0–1 (B), mortality (C), and symptomatic intracranial hemorrhage (D). Effects are shown separately for patients with internal carotid artery (ICA), proximal middle cerebral artery (MCA), distal MCA, and M2 occlusions. Corresponding odds ratios and their 95% confidence intervals are listed in table 3.

**Figure 2. Distribution of 90-day functional outcome according to the modified Rankin Scale (mRS) stratified by reperfusion status and arterial occlusive lesion (AOL)**
The graphs show the distribution of 90-day functional outcomes according to the mRS score stratified by reperfusion status and AOL (internal carotid artery [ICA], proximal middle cerebral artery [MCA], and distal MCA occlusions). Reperfusion is associated with better functional outcomes, assessed using the full distribution of mRS scores, in patients with ICA (odds ratio [OR] 2.9; 95% confidence interval [CI] 1.6–5.2) and proximal MCA occlusions (OR 5.0; 95% CI 3.3–7.4), but not in patients with distal MCA occlusions (OR 1.2; 95% CI 0.7–2.1).

See this image and copyright information in PMC

References

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Effect of endovascular reperfusion in relation to site of arterial occlusion

Collaborators

Affiliations

Effect of endovascular reperfusion in relation to site of arterial occlusion

Authors

Collaborators

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Molecular Biology Databases

Miscellaneous