Published Online
on December 22, 2005

A more recent version of this article appeared on February 1, 2006

This Article Full Text (PDF) All Versions of this Article: 37/2/419    most recent 01.STR.0000198808.90579.65v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Choi, J. H. Articles by Pile-Spellman, J. Search for Related Content PubMed PubMed Citation Articles by Choi, J. H. Articles by Pile-Spellman, J. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Emergency treatment of Stroke Thrombolysis

Submitted on October 27, 2005
Accepted on November 21, 2005

Endovascular Recanalization Therapy in Acute Ischemic Stroke

Jae H. Choi MD^*; Brian T. Bateman BA; Sundeep Mangla MD; Randolph S. Marshall MD; Shyam Prabhakaran MD; Ji Chong MD; Jay P. Mohr MD; Henning Mast MD; and John Pile-Spellman MD

From the Stroke Center, the Neurological Institute (J.H.C., R.S.M., S.P., J.C., J.P.M, H.M., J.P.S.) and the Academic Interventional Neuroradiology, the Department of Radiology (J.P.S., J.H.C.), New York-Presbyterian Hospital/Columbia University Medical Center, the College of Physicians and Surgeons, Columbia University (B.T.B.), New York, NY; the Departments of Radiology, Neurosurgery, and Neurology (S.M.), SUNY Downstate Health Science Center, Brooklyn, NY; and the Department of Neurology, Bergmannstrost, Halle, Germany (J.H.C., H.M.).

^* To whom correspondence should be addressed. E-mail: jchoi{at}neuro.columbia.edu.

Background and Purpose--To assess the outcome in acute ischemic stroke patients not eligible for systemic thrombolysis (outside the 3-hour time window, after surgery, or on anticoagulant) undergoing endovascular recanalization therapy (ERT) at the Columbia University Medical Center (CUMC) and to determine US nationwide usage and outcome of ERT in acute ischemic stroke.

Methods--Patients treated at CUMC from 2001 to 2004 and the Nationwide Inpatient Sample (NIS) comprising 20% of all admissions in the United States from 1999 to 2002 were analyzed retrospectively.

Results--Thirty-one patients underwent ERT. Mean age was 68±14 years, 68% were female, and 45% nonwhite (occlusion sites: internal carotid artery 29%; middle cerebral artery 39%; posterior circulation 32%). Pharmacological or mechanical ERT was initiated beyond 3 hours after symptom onset (median time 4.4 hours) in 61%, 29% had surgery, and 39% were on anticoagulant medication. At discharge, 32% had modified Rankin Scale scores of 0 to 2 (52% discharged home or to rehabilitation facilities); overall mortality was 29%, of which 19% were fatal intracerebral hemorrhages. From the NIS cohort, 477 patients (0.17% of all strokes and 14% of all thrombolysis cases) underwent ERT. Fifteen percent died, and 50% were discharged home or to rehabilitation facilities. Intracerebral hemorrhage occurred in 6%. Fewer good outcomes of the CUMC cohort may be explained by more unfavorable premorbid patient characteristics compared with the NIS cohort.

Conclusion--Despite significant variability in patient characteristics and treatment methods among 2 sources of data analyzed, ERT in stroke patients not eligible for intravenous thrombolysis appears to be a relatively safe and effective treatment alternative that is being used increasingly nationwide.

Key words: endovascular therapy • stroke, acute • treatment outcome • thrombolysis

This article has been cited by other articles:

				J A Hirsch, A J Yoo, R G Nogueira, L A Verduzco, L H Schwamm, J C Pryor, J D Rabinov, and R G Gonzalez Case volumes of intra-arterial and intravenous treatment of ischemic stroke in the USA JNIS, July 3, 2009; (2009) jnis.2009.000166v1. [Abstract] [Full Text] [PDF]

				H.J. Cloft, A. Rabinstein, G. Lanzino, and D.F. Kallmes Intra-Arterial Stroke Therapy: An Assessment of Demand and Available Work Force AJNR Am. J. Neuroradiol., March 1, 2009; 30(3): 453 - 458. [Abstract] [Full Text] [PDF]

				G. Stoll, C. Kleinschnitz, and B. Nieswandt Molecular mechanisms of thrombus formation in ischemic stroke: novel insights and targets for treatment Blood, November 1, 2008; 112(9): 3555 - 3562. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]