Published Online
on March 9, 2006

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

This Article Full Text (PDF) All Versions of this Article: 37/4/986    most recent 01.STR.0000209303.02474.27v1 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 Gupta, R. Articles by Jovin, T. G. Search for Related Content PubMed PubMed Citation Articles by Gupta, R. Articles by Jovin, T. G. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Acute Cerebral Infarction Thrombolysis Angioplasty and Stenting

Submitted on November 30, 2005
Revised on January 6, 2006
Accepted on January 9, 2006

Multimodal Reperfusion Therapy for Acute Ischemic Stroke. Factors Predicting Vessel Recanalization

Rishi Gupta MD; Nirav A. Vora MD; Michael B. Horowitz MD; Ashis H. Tayal MD; Maxim D. Hammer MD; Ken Uchino MD; Elad I. Levy; Lawrence R. Wechsler MD; and Tudor G. Jovin MD^*

From the Department of Neurology (R.G., N.A.V., A.H.T., M.D.H., K.U., L.R.W., T.G.J.), Stroke Institute, University of Pittsburgh Medical Center, Pennsylvania; Departments of Neurosurgery and Radiology (M.B.H.), University of Pittsburgh Medical Center, Pennsylvania; VA Health Systems Pittsburgh (T.G.J.), University Drive, Pittsburgh, Pa; Department of Neurosurgery (E.I.L.), University of Buffalo, State University of New York.

^* To whom correspondence should be addressed. E-mail: jovintg{at}upmc.edu.

Background and Purpose--Endovascular therapies using mechanical and pharmacological modalities for large vessel occlusions in acute stroke are rapidly evolving. Our aim was to determine whether one modality is associated with higher recanalization rates.

Methods--We retrospectively reviewed 168 consecutive patients treated with intra-arterial (IA) therapy for acute ischemic stroke between May 1999 and November 15, 2005. Demographic, clinical, radiographic, angiographic, and procedural notes were reviewed. Recanalization was defined as achieving thrombolysis in myocardial infarction 2 or 3 flow after intervention. A logistic regression model was constructed to determine independent predictors of successful recanalization.

Results--A total of 168 patients were reviewed with a mean age of 64±13 years and mean National Institutes of Health Stroke Scale score of 17±4. Recanalization was achieved in 106 (63%) patients. Independent predictors of recanalization include: the combination of IA thrombolytics and glycoprotein IIb/IIIa inhibitors (odds ratio [OR], 2.9 [95% CI, 1.04 to 6.7]; P<0.048), intracranial stent placement with angioplasty (OR, 4.8 [95% CI, 1.8 to 10.0]; P<0.001), or extracranial stent placement with angioplasty (OR, 4.2 [95% CI, 1.4 to 9.8]; P<0.014). Lesions at the terminus of the internal carotid artery were recalcitrant to revascularization (OR, 0.34 [95% CI, 0.16 to 0.73]; P value 0.006).

Conclusions--Intracranial or extracranial stenting or combination therapy with IA thrombolytics and glycoprotein IIb/IIIa inhibitors in the setting of multimodal therapy is associated with successful recanalization in patients treated with multimodal endovascular reperfusion therapy for acute ischemic stroke.

Key words: stents • stroke, acute • thrombolysis

This article has been cited by other articles:

				A. Gruber Interventional Management of Stroke Stroke, June 1, 2008; 39(6): 1663 - 1664. [Full Text] [PDF]

				N.A. Vora, R. Gupta, A.J. Thomas, M.B. Horowitz, A.H. Tayal, M.D. Hammer, K. Uchino, L.R. Wechsler, and T.G. Jovin Factors Predicting Hemorrhagic Complications after Multimodal Reperfusion Therapy for Acute Ischemic Stroke AJNR Am. J. Neuroradiol., August 1, 2007; 28(7): 1391 - 1394. [Abstract] [Full Text] [PDF]

				E.I. Levy, R. Mehta, R. Gupta, R.A. Hanel, A.J. Chamczuk, D. Fiorella, H.H. Woo, F.C. Albuquerque, T.G. Jovin, M.B. Horowitz, et al. Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions AJNR Am. J. Neuroradiol., May 1, 2007; 28(5): 816 - 822. [Abstract] [Full Text] [PDF]

				D. M. Pelz, E. I. Levy, and L. N. Hopkins Advances in Interventional Neuroradiology 2006 Stroke, February 1, 2007; 38(2): 232 - 234. [Full Text] [PDF]