Effect of endovascular reperfusion in relation to site of arterial occlusion
Citation Manager Formats
Make Comment
See Comments

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
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
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Dr. Sevil Yaşar and Dr. Behnam Sabayan
► Watch
Topics Discussed
Alert Me
Recommended articles
-
Article
Comparison of the response to endovascular reperfusion in relation to site of arterial occlusionRobin Lemmens, Michael Mlynash, Matus Straka et al.Neurology, July 12, 2013 -
Article
Prevalence of stenoses and occlusions of brain-supplying arteries in young stroke patientsBettina von Sarnowski, Ulf Schminke, Turgut Tatlisumak et al.Neurology, March 06, 2013 -
Clinical/Scientific Notes
Deterioration following improvement with tPA therapy: Carotid thrombosis and reocclusionW. Scott Burgin, Andrei V. Alexandrov et al.Neurology, February 27, 2001 -
Articles
Long-term changes of hemodynamics and metabolism after carotid artery occlusionH. Yamauchi, H. Fukuyama, Y. Nagahama et al.Neurology, June 13, 2000