Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
- 주제(키워드) Ischemia , Stroke , Thrombosis , Thrombolysis , Reperfusion
- 주제(기타) Clinical Neurology
- 주제(기타) Peripheral Vascular Disease
- 설명문(일반) [Kim, Young Dae; Nam, Hyo Suk; Park, Hyungjong; Heo, JoonNyung; Choi, Jin Kyo; Heo, Ji Hoe] Yonsei Univ, Dept Neurol, Coll Med, 50-1 Yonsei Ro, Seoul 03722, South Korea; [Yoo, Joonsang; Park, Hyungjong; Sohn, Sung-Il; Hong, Jeong-Ho] Keimyung Univ, Brain Res Inst, Dept Neurol, Sch Med, Daegu, South Korea; [Yoo, Joonsang; Kim, Jinkwon] Yonsei Univ, Yongin Severance Hosp, Dept Neurol, Coll Med, Yongin, South Korea; [Kim, Byung Moon; Kim, Dong Joon; Choi, Jin Kyo] Yonsei Univ, Dept Radiol, Coll Med, Seoul, South Korea; [Bang, Oh Young; Seo, Woo-Keun; Chung, Jong-Won] Sungkyunkwan Univ, Samsung Med Ctr, Dept Neurol, Sch Med, Seoul, South Korea; [Lee, Kyung-Yul; Jung, Yo Han] Yonsei Univ, Severance Inst Vasc & Metab Res, Coll Med, Dept Neurol,Gangnam Severance Hosp, Seoul, South Korea; [Jung, Yo Han] Changwon Fatima Hosp, Dept Neurol, Chang Won, South Korea; [Lee, Hye Sun] Yonsei Univ, Dept Res Affairs, Biostat Collaborat Unit, Coll Med, Seoul, South Korea; [Ahn, Seong Hwan] Chosun Univ, Dept Neurol, Coll Med, Gwangju, South Korea; [Shin, Dong Hoon] Gachon Univ, Dept Neurol, Gil Med Ctr, Incheon, South Korea; [Choi, Hye-Yeon] Kyung Hee Univ, Sch Med, Kyung Hee Univ Hosp Gangdong, Dept Neurol, Seoul, South Korea; [Cho, Han-Jin] Pusan Natl Univ, Dept Neurol, Sch Med, Busan, South Korea; [Baek, Jang-Hyun] Natl Med Ctr, Dept Neurol, Seoul, South Korea; [Baek, Jang-Hyun] Sungkyunkwan Univ, Kangbuk Samsung Hosp, Dept Neurol, Sch Med, Seoul, South Korea; [Kim, Gyu Sik; Seo, Kwon-Duk] Natl Hlth Insurance Serv Ilsan Hosp, Dept Neurol, Goyang, South Korea; [Seo, Kwon-Duk; Lee, Sung Ik] Wonkwang Univ, Sanbon Hosp, Sch Med, Dept Neurol, Sanbon, South Korea; [Kim, Seo Hyun] Yonsei Univ, Dept Neurol, Wonju Coll Med, Wonju, South Korea; [Song, Tae-Jin] Ewha Womans Univ, Sch Med, Mokdong Hosp, Dept Neurol, Seoul, South Korea; [Song, Tae-Jin] Ewha Womans Univ, Sch Med, Seoul Hosp, Dept Neurol, Seoul, South Korea; [Kim, Jinkwon] CHA Univ, CHA Bundang Med Ctr, Dept Neurol, Seongnam, South Korea; [Han, Sang Won; Park, Joong Hyun] Inje Univ, Coll Med, Sanggye Paik Hosp, Dept Neurol, Seoul, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 KOREAN STROKE SOC
- 발행년도 2021
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000181622
- 본문언어 영어
- Published As http://dx.doi.org/10.5853//jos.2020.03622
초록/요약
Background and Purpose We aimed to develop a model predicting early recanalization after in-travenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. Methods Using data from two different multicenter prospective cohorts, we determined the fac-tors associated with early recanalization immediately after t-PA in stroke patients with large-ves-sel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. Results Early recanalization, assessed 61.0 +/- 44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). Conclusions The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.
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