February 23, 2016; 86 (8) Article
Effect of endovascular reperfusion in relation to site of arterial occlusion
Robin Lemmens, Scott A. Hamilton, David S. Liebeskind, Tom A. Tomsick, Andrew M. Demchuk, Raul G. Nogueira, Michael P. Marks, Reza Jahan, Jan Gralla, Albert J. Yoo, Sharon D. Yeatts, Yuko Y. Palesch, Jeffrey L. Saver, Vitor M. Pereira, Joseph P. Broderick, Gregory W. Albers, Maarten G. Lansberg, For the DEFUSE 2, IMS III, STAR, and SWIFT trialists
First published January 22, 2016, DOI: https://doi.org/10.1212/WNL.0000000000002399
Robin Lemmens
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.
Scott A. Hamilton
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.
David S. Liebeskind
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.
Tom A. Tomsick
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.
Andrew M. Demchuk
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.
Raul G. Nogueira
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.
Michael P. Marks
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.
Reza Jahan
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.
Jan Gralla
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.
Albert J. Yoo
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.
Sharon D. Yeatts
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.
Yuko Y. Palesch
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.
Jeffrey L. Saver
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.
Vitor M. Pereira
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.
Joseph P. Broderick
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.
Gregory W. Albers
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.
Maarten G. Lansberg
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.
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.
Effect of endovascular reperfusion in relation to site of arterial occlusion
Robin Lemmens, Scott A. Hamilton, David S. Liebeskind, Tom A. Tomsick, Andrew M. Demchuk, Raul G. Nogueira, Michael P. Marks, Reza Jahan, Jan Gralla, Albert J. Yoo, Sharon D. Yeatts, Yuko Y. Palesch, Jeffrey L. Saver, Vitor M. Pereira, Joseph P. Broderick, Gregory W. Albers, Maarten G. Lansberg, For the DEFUSE 2, IMS III, STAR, and SWIFT trialists
Neurology Feb 2016, 86 (8) 762-770; DOI: 10.1212/WNL.0000000000002399
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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.
GLOSSARY
- AOL=
- arterial occlusive lesion;
- CI=
- confidence interval;
- DEFUSE 2=
- Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2;
- ICA=
- internal carotid artery;
- IMS III=
- Interventional Management of Stroke Trial;
- M1=
- proximal middle cerebral artery;
- M2/3/4=
- distal middle cerebral artery;
- MCA=
- middle cerebral artery;
- MERCI=
- Mechanical Embolus Removal in Cerebral Ischemia;
- MR=
- magnetic resonance;
- mRS=
- modified Rankin Scale;
- mTICI=
- modified Thrombolysis in Cerebral Infarction;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- sICH=
- symptomatic intracranial hemorrhage;
- STAR=
- Solitaire FR Thrombectomy for Acute Revascularisation;
- SWIFT=
- Solitaire With the Intention for Thrombectomy;
- tPA=
- tissue plasminogen activator
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Coinvestigators are listed on the Neurology® Web site at Neurology.org.
Supplemental data at Neurology.org
- Received June 5, 2015.
- Accepted in final form October 28, 2015.
- © 2016 American Academy of Neurology
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