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<meta name="DC.Title" content="Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2006" />
<meta name="DC.Date" content="2010-03-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with “futile recanalization,” defined by absence of clinical benefit from recanalization, following endovascular treatment of acute ischemic stroke.

MATERIALS AND METHODS: Data from 6 studies of acute ischemic stroke treated with mechanical and/or pharmacologic endovascular treatment were analyzed. “Futile recanalization” was defined by the occurrence of unfavorable outcome (mRS score of ≥3 at 1–3 months) despite complete angiographic recanalization (Qureshi grade 0 or TIMI grade 3).

RESULTS: Complete recanalization was observed in 96 of 270 patients treated with IA thrombolysis. Futile recanalization was observed in 47 (49%). In univariate analysis, patients with futile recanalization were older (73 ± 11 versus 58 ± 15 years, P &lt; .0001) and had higher median initial NIHSS scores (19 versus 14, P &lt; .0001), more frequent BA occlusion (17% versus 4%, P = .049), less frequent MCA occlusion (53% versus 76%, P = .032), and a nonsignificantly higher rate of symptomatic hemorrhagic complications (2% versus 9%, P = .2). In logistic regression analysis, futile recanalization was positively associated with age &gt;70 years (OR, 4.4; 95% CI, 1.9–10.5; P = .0008) and initial NIHSS score 10–19 (OR, 3.8; 95% CI, 1.7–8.4; P = .001), and initial NIHSS score ≥20 (OR, 64.4; 95% CI, 28.8–144; P &lt; .0001).

CONCLUSIONS: Futile recanalization is a relatively common occurrence following endovascular treatment, particularly among elderly patients and those with severe neurologic deficits.

ACA
:   anterior cerebral artery
BA
:   basilar artery
CI
:   confidence interval
Gp IIb/IIIa
:   glycoprotein IIb/IIIa
h
:   hour
IA
:   intra-arterial
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IMS
:   Interventional Management of Stroke
IV
:   intravenous
MCA
:   middle cerebral artery
MERCI
:   Mechanical Embolus Removal in Cerebral Ischemia
mRS
:   modified Rankin Scale
N/A
:   not applicable
NIHSS
:   National Institutes of Health Stroke Scale
NINDS
:   National Institute of Neurological Disorders and Stroke
OR
:   odds ratio
PCA
:   posterior cerebral artery
PROACT
:   Prolyse in Acute Cerebral Thromboembolism
rtPA
:   recombinant tissue plasminogen activator
TIMI
:   Thrombolysis in Myocardial Infarction
VA
:   vertebral artery" />
<meta name="DC.Contributor" content="H.M. Hussein" />
<meta name="DC.Contributor" content="A.L. Georgiadis" />
<meta name="DC.Contributor" content="G. Vazquez" />
<meta name="DC.Contributor" content="J.T. Miley" />
<meta name="DC.Contributor" content="M.Z. Memon" />
<meta name="DC.Contributor" content="Y.M. Mohammad" />
<meta name="DC.Contributor" content="G.A. Christoforidis" />
<meta name="DC.Contributor" content="N. Tariq" />
<meta name="DC.Contributor" content="A.I. Qureshi" />
<meta name="article:published_time" content="2010-03-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with “futile recanalization,” defined by absence of clinical benefit from recanalization, following endovascular treatment of acute ischemic stroke.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Data from 6 studies of acute ischemic stroke treated with mechanical and/or pharmacologic endovascular treatment were analyzed. “Futile recanalization” was defined by the occurrence of unfavorable outcome (mRS score of ≥3 at 1–3 months) despite complete angiographic recanalization (Qureshi grade 0 or TIMI grade 3).&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Complete recanalization was observed in 96 of 270 patients treated with IA thrombolysis. Futile recanalization was observed in 47 (49%). In univariate analysis, patients with futile recanalization were older (73 ± 11 versus 58 ± 15 years, &lt;i&gt;P&lt;/i&gt; &amp;lt; .0001) and had higher median initial NIHSS scores (19 versus 14, &lt;i&gt;P&lt;/i&gt; &amp;lt; .0001), more frequent BA occlusion (17% versus 4%, &lt;i&gt;P&lt;/i&gt; = .049), less frequent MCA occlusion (53% versus 76%, &lt;i&gt;P&lt;/i&gt; = .032), and a nonsignificantly higher rate of symptomatic hemorrhagic complications (2% versus 9%, &lt;i&gt;P&lt;/i&gt; = .2). In logistic regression analysis, futile recanalization was positively associated with age &amp;gt;70 years (OR, 4.4; 95% CI, 1.9–10.5; &lt;i&gt;P&lt;/i&gt; = .0008) and initial NIHSS score 10–19 (OR, 3.8; 95% CI, 1.7–8.4; &lt;i&gt;P&lt;/i&gt; = .001), and initial NIHSS score ≥20 (OR, 64.4; 95% CI, 28.8–144; &lt;i&gt;P&lt;/i&gt; &amp;lt; .0001).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Futile recanalization is a relatively common occurrence following endovascular treatment, particularly among elderly patients and those with severe neurologic deficits.&lt;/p&gt;" />
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<meta name="twitter:title" content="Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study" />
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<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/31/3.cover.gif" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with “futile recanalization,” defined by absence of clinical benefit from recanalization, following endovascular treatment of acute ischemic stroke.

MATERIALS AND METHODS: Data from 6 studies of acute ischemic stroke treated with mechanical and/or pharmacologic endovascular treatment were analyzed. “Futile recanalization” was defined by the occurrence of unfavorable outcome (mRS score of ≥3 at 1–3 months) despite complete angiographic recanalization (Qureshi grade 0 or TIMI grade 3).

RESULTS: Complete recanalization was observed in 96 of 270 patients treated with IA thrombolysis. Futile recanalization was observed in 47 (49%). In univariate analysis, patients with futile recanalization were older (73 ± 11 versus 58 ± 15 years, P &lt; .0001) and had higher median initial NIHSS scores (19 versus 14, P &lt; .0001), more frequent BA occlusion (17% versus 4%, P = .049), less frequent MCA occlusion (53% versus 76%, P = .032), and a nonsignificantly higher rate of symptomatic hemorrhagic complications (2% versus 9%, P = .2). In logistic regression analysis, futile recanalization was positively associated with age &gt;70 years (OR, 4.4; 95% CI, 1.9–10.5; P = .0008) and initial NIHSS score 10–19 (OR, 3.8; 95% CI, 1.7–8.4; P = .001), and initial NIHSS score ≥20 (OR, 64.4; 95% CI, 28.8–144; P &lt; .0001).

CONCLUSIONS: Futile recanalization is a relatively common occurrence following endovascular treatment, particularly among elderly patients and those with severe neurologic deficits.

ACA
:   anterior cerebral artery
BA
:   basilar artery
CI
:   confidence interval
Gp IIb/IIIa
:   glycoprotein IIb/IIIa
h
:   hour
IA
:   intra-arterial
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IMS
:   Interventional Management of Stroke
IV
:   intravenous
MCA
:   middle cerebral artery
MERCI
:   Mechanical Embolus Removal in Cerebral Ischemia
mRS
:   modified Rankin Scale
N/A
:   not applicable
NIHSS
:   National Institutes of Health Stroke Scale
NINDS
:   National Institute of Neurological Disorders and Stroke
OR
:   odds ratio
PCA
:   posterior cerebral artery
PROACT
:   Prolyse in Acute Cerebral Thromboembolism
rtPA
:   recombinant tissue plasminogen activator
TIMI
:   Thrombolysis in Myocardial Infarction
VA
:   vertebral artery" />
<meta name="og-title" property="og:title" content="Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/3/454" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with “futile recanalization,” defined by absence of clinical benefit from recanalization, following endovascular treatment of acute ischemic stroke.

MATERIALS AND METHODS: Data from 6 studies of acute ischemic stroke treated with mechanical and/or pharmacologic endovascular treatment were analyzed. “Futile recanalization” was defined by the occurrence of unfavorable outcome (mRS score of ≥3 at 1–3 months) despite complete angiographic recanalization (Qureshi grade 0 or TIMI grade 3).

RESULTS: Complete recanalization was observed in 96 of 270 patients treated with IA thrombolysis. Futile recanalization was observed in 47 (49%). In univariate analysis, patients with futile recanalization were older (73 ± 11 versus 58 ± 15 years, P &lt; .0001) and had higher median initial NIHSS scores (19 versus 14, P &lt; .0001), more frequent BA occlusion (17% versus 4%, P = .049), less frequent MCA occlusion (53% versus 76%, P = .032), and a nonsignificantly higher rate of symptomatic hemorrhagic complications (2% versus 9%, P = .2). In logistic regression analysis, futile recanalization was positively associated with age &gt;70 years (OR, 4.4; 95% CI, 1.9–10.5; P = .0008) and initial NIHSS score 10–19 (OR, 3.8; 95% CI, 1.7–8.4; P = .001), and initial NIHSS score ≥20 (OR, 64.4; 95% CI, 28.8–144; P &lt; .0001).

CONCLUSIONS: Futile recanalization is a relatively common occurrence following endovascular treatment, particularly among elderly patients and those with severe neurologic deficits.

ACA
:   anterior cerebral artery
BA
:   basilar artery
CI
:   confidence interval
Gp IIb/IIIa
:   glycoprotein IIb/IIIa
h
:   hour
IA
:   intra-arterial
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IMS
:   Interventional Management of Stroke
IV
:   intravenous
MCA
:   middle cerebral artery
MERCI
:   Mechanical Embolus Removal in Cerebral Ischemia
mRS
:   modified Rankin Scale
N/A
:   not applicable
NIHSS
:   National Institutes of Health Stroke Scale
NINDS
:   National Institute of Neurological Disorders and Stroke
OR
:   odds ratio
PCA
:   posterior cerebral artery
PROACT
:   Prolyse in Acute Cerebral Thromboembolism
rtPA
:   recombinant tissue plasminogen activator
TIMI
:   Thrombolysis in Myocardial Infarction
VA
:   vertebral artery" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node9618" data-node-nid="9618" id="top-node-9618--2609388573" data-pisa="ajnr;31/3/454" data-pisa-master="ajnr;ajnr.A2006" data-apath="/ajnr/31/3/454.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Interventional</span></span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-series highwire-cite-metadata">E</span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="ajnr;ajnr.A2006" data-atom-uri="/ajnr/31/3/454.atom" data-request-view="full"></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">H.M. Hussein</span>, <span class="highwire-citation-author" data-delta="1">A.L. Georgiadis</span>, <span class="highwire-citation-author" data-delta="2">G. Vazquez</span>, <span class="highwire-citation-author" data-delta="3">J.T. Miley</span>, <span class="highwire-citation-author" data-delta="4">M.Z. Memon</span>, <span class="highwire-citation-author" data-delta="5">Y.M. Mohammad</span>, <span class="highwire-citation-author" data-delta="6">G.A. Christoforidis</span>, <span class="highwire-citation-author" data-delta="7">N. Tariq</span> and <span class="highwire-citation-author" data-delta="8">A.I. Qureshi</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">454-458; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2006 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9618--2609388573" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">H.M. Hussein </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.M.%2BHussein%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hussein%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.M.%2BHussein%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">A.L. Georgiadis </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.L.%2BGeorgiadis%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Georgiadis%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.L.%2BGeorgiadis%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">G. Vazquez </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BVazquez%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Vazquez%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.%2BVazquez%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">J.T. Miley </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.T.%2BMiley%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Miley%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.T.%2BMiley%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">M.Z. 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Mohammad </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.M.%2BMohammad%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mohammad%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AY.M.%2BMohammad%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">G.A. Christoforidis </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.A.%2BChristoforidis%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Christoforidis%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.A.%2BChristoforidis%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">N. Tariq </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BTariq%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Tariq%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AN.%2BTariq%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">A.I. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.1" data-doi="10.1161/01.STR.0000258112.14918.24"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Rha</span>  <span class="cit-name-given-names">JH</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Saver</span>  <span class="cit-name-given-names">JL</span></span></li></ol><cite>. <span class="cit-article-title">The impact of recanalization on ischemic stroke outcome: a meta-analysis</span>. <abbr class="cit-jnl-abbrev">Stroke</abbr> <span class="cit-pub-date">2007</span>;<span class="cit-vol">38</span>:<span class="cit-fpage">967</span>–<span class="cit-lpage">73</span>
</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjg6IjM4LzMvOTY3IjtzOjQ6ImF0b20iO3M6MTk6Ii9ham5yLzMxLzMvNDU0LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div>
</li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.2" data-doi="10.1161/STROKEAHA.107.483131"><div class="cit-metadata"><cite><span class="cit-auth cit-collab">IMS II Trial Investigators</span>. <span class="cit-article-title">The Interventional Management of Stroke (IMS) II study</span>. <abbr class="cit-jnl-abbrev">Stroke</abbr> <span class="cit-pub-date">2007</span>;<span class="cit-vol">38</span>:<span class="cit-fpage">2127</span>–<span class="cit-lpage">35</span>. <span class="cit-comment">Epub 2007 May 24</span>
</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjk6IjM4LzcvMjEyNyI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8zMS8zLzQ1NC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div>
</li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.3" data-doi="10.1001/jama.282.21.2003"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Furlan</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Higashida</span>  <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Wechsler</span>  <span class="cit-name-given-names">L</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Intra-arterial prourokinase for acute ischemic stroke: the PROACT II study—a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism</span>. <abbr class="cit-jnl-abbrev">JAMA</abbr> <span class="cit-pub-date">1999</span>;<span class="cit-vol">282</span>:<span class="cit-fpage">2003</span>–<span class="cit-lpage">11</span>
</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1001/jama.282.21.2003&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=10591382&amp;link_type=MED&amp;atom=%2Fajnr%2F31%2F3%2F454.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000083908700019&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div>
</li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.4" data-doi="10.1056/NEJMoa041175"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Alexandrov</span>  <span class="cit-name-given-names">AV</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Molina</span>  <span class="cit-name-given-names">CA</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Grotta</span>  <span class="cit-name-given-names">JC</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke</span>. <abbr class="cit-jnl-abbrev">N Engl J Med</abbr> <span class="cit-pub-date">2004</span>;<span class="cit-vol">351</span>:<span class="cit-fpage">2170</span>–<span class="cit-lpage">78</span>
</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1056/NEJMoa041175&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=15548777&amp;link_type=MED&amp;atom=%2Fajnr%2F31%2F3%2F454.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000225160600007&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div>
</li><li><span class="ref-label">5.</span><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5. in text" id="ref-5">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.5" data-doi="10.1161/01.STR.0000171066.25248.1d"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Smith</span>  <span class="cit-name-given-names">WS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Sung</span>  <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Starkman</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial</span>. <abbr class="cit-jnl-abbrev">Stroke</abbr> <span class="cit-pub-date">2005</span>;<span class="cit-vol">36</span>:<span class="cit-fpage">1432</span>–<span class="cit-lpage">38</span>. <span class="cit-comment">Epub 2005 Jun 16</span>
</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjk6IjM2LzcvMTQzMiI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8zMS8zLzQ1NC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div>
</li><li><span class="ref-label">6.</span><a class="rev-xref-ref" href="#xref-ref-6-1" title="View reference 6. in text" id="ref-6">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.6"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Smith</span>  <span class="cit-name-given-names">WS</span></span></li></ol><cite>. <span class="cit-article-title">Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke: results of the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">27</span>:<span class="cit-fpage">1177</span>–<span class="cit-lpage">82</span>
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</li><li><span class="ref-label">7.</span><a class="rev-xref-ref" href="#xref-ref-7-1" title="View reference 7. in text" id="ref-7">↵</a>

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</li><li><span class="ref-label">8.</span><a class="rev-xref-ref" href="#xref-ref-8-1" title="View reference 8. in text" id="ref-8">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.8" data-doi="10.1161/STROKEAHA.107.181486"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Adams</span>  <span class="cit-name-given-names">HP</span>  <span class="cit-name-suffix">Jr</span>.</span>, </li><li><span class="cit-auth"><span class="cit-name-surname">del Zoppo</span>  <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Alberts</span>  <span class="cit-name-given-names">MJ</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">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</span>. <abbr class="cit-jnl-abbrev">Stroke</abbr> <span class="cit-pub-date">2007</span>;<span class="cit-vol">38</span>:<span class="cit-fpage">1655</span>–<span class="cit-lpage">711</span>. <span class="cit-comment">Epub 2007 Apr 12</span>
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</li><li><span class="ref-label">9.</span><a class="rev-xref-ref" href="#xref-ref-9-1" title="View reference 9. in text" id="ref-9">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.9" data-doi="10.1161/01.STR.0000082721.62796.09"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Higashida</span>  <span class="cit-name-given-names">RT</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Furlan</span>  <span class="cit-name-given-names">AJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Roberts</span>  <span class="cit-name-given-names">H</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke</span>. <abbr class="cit-jnl-abbrev">Stroke</abbr> <span class="cit-pub-date">2003</span>;<span class="cit-vol">34</span>:<span class="cit-fpage">e109</span>–<span class="cit-lpage">37</span>
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</li><li><span class="ref-label">10.</span><a class="rev-xref-ref" href="#xref-ref-10-1" title="View reference 10. in text" id="ref-10">↵</a>

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</li><li><span class="ref-label">11.</span><a class="rev-xref-ref" href="#xref-ref-11-1" title="View reference 11. in text" id="ref-11">↵</a>

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</li><li><span class="ref-label">12.</span><a class="rev-xref-ref" href="#xref-ref-12-1" title="View reference 12. in text" id="ref-12">↵</a>

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</li><li><span class="ref-label">13.</span><a class="rev-xref-ref" href="#xref-ref-13-1" title="View reference 13. in text" id="ref-13">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.13"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Mahon</span>  <span class="cit-name-given-names">BR</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Nesbit</span>  <span class="cit-name-given-names">GM</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Barnwell</span>  <span class="cit-name-given-names">SL</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">North American clinical experience with the EKOS MicroLysUS infusion catheter for the treatment of embolic stroke</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2003</span>;<span class="cit-vol">24</span>:<span class="cit-fpage">534</span>–<span class="cit-lpage">48</span>
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</li><li><span class="ref-label">14.</span><a class="rev-xref-ref" href="#xref-ref-14-1" title="View reference 14. in text" id="ref-14">↵</a>

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</li><li><span class="ref-label">15.</span><a class="rev-xref-ref" href="#xref-ref-15-1" title="View reference 15. in text" id="ref-15">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.15"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Miley</span>  <span class="cit-name-given-names">JT</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Memon</span>  <span class="cit-name-given-names">MZ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Hussein</span>  <span class="cit-name-given-names">HM</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">A multicenter analysis of “time to microcatheter” for endovascular therapy in acute ischemic stroke</span>. <abbr class="cit-jnl-abbrev">J Neuroimaging</abbr> <span class="cit-pub-date">2009</span> <span class="cit-month">10</span> <span class="cit-day">7</span>. [<span class="cit-comment">Epub ahead of print</span>]
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</li><li><span class="ref-label">16.</span><a class="rev-xref-ref" href="#xref-ref-16-1" title="View reference 16. in text" id="ref-16">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.16"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Christoforidis</span>  <span class="cit-name-given-names">GA</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Mohammad</span>  <span class="cit-name-given-names">Y</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Avutu</span>  <span class="cit-name-given-names">B</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Arteriographic demonstration of slow antegrade opacification distal to a cerebrovascular thromboembolic occlusion site as a favorable indicator for intra-arterial thrombolysis</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">27</span>:<span class="cit-fpage">1528</span>–<span class="cit-lpage">31</span>
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</li><li><span class="ref-label">17.</span><a class="rev-xref-ref" href="#xref-ref-17-1" title="View reference 17. in text" id="ref-17">↵</a>

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</li><li><span class="ref-label">57.</span><a class="rev-xref-ref" href="#xref-ref-57-1" title="View reference 57. in text" id="ref-57">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.57"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Janardhan</span>  <span class="cit-name-given-names">V</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Qureshi</span>  <span class="cit-name-given-names">AI</span></span></li></ol><cite>. <span class="cit-article-title">Mechanisms of ischemic brain injury</span>. <abbr class="cit-jnl-abbrev">Curr Cardiol Rep</abbr> <span class="cit-pub-date">2004</span>;<span class="cit-vol">6</span>:<span class="cit-fpage">117</span>–<span class="cit-lpage">23</span>
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</li><li><span class="ref-label">58.</span><a class="rev-xref-ref" href="#xref-ref-58-1" title="View reference 58. in text" id="ref-58">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.58" data-doi="10.1016/S0735-1097(00)00865-2"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Morishima</span>  <span class="cit-name-given-names">I</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Sone</span>  <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Okumura</span>  <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction</span>. <abbr class="cit-jnl-abbrev">J Am Coll Cardiol</abbr> <span class="cit-pub-date">2000</span>;<span class="cit-vol">36</span>:<span class="cit-fpage">1202</span>–<span class="cit-lpage">09</span>
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</li><li><span class="ref-label">59.</span><a class="rev-xref-ref" href="#xref-ref-59-1" title="View reference 59. in text" id="ref-59">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.3.454.59" data-doi="10.1161/01.CIR.101.2.125"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Gibson</span>  <span class="cit-name-given-names">CM</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Cannon</span>  <span class="cit-name-given-names">CP</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Murphy</span>  <span class="cit-name-given-names">SA</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs</span>. <abbr class="cit-jnl-abbrev">Circulation</abbr> <span class="cit-pub-date">2000</span>;<span class="cit-vol">101</span>:<span class="cit-fpage">125</span>–<span class="cit-lpage">30</span>
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 31</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 3 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Mar 2010 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">H.M.</span> <span class="nlm-surname">Hussein</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A.L.</span> <span class="nlm-surname">Georgiadis</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Vazquez</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">J.T.</span> <span class="nlm-surname">Miley</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">M.Z.</span> <span class="nlm-surname">Memon</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Y.M.</span> <span class="nlm-surname">Mohammad</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">G.A.</span> <span class="nlm-surname">Christoforidis</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Tariq</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">A.I.</span> <span class="nlm-surname">Qureshi</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">454-458; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2006 </span></div>
  
  
  
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      <div class="highwire-cite-title">Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">H.M.</span> <span class="nlm-surname">Hussein</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A.L.</span> <span class="nlm-surname">Georgiadis</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Vazquez</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">J.T.</span> <span class="nlm-surname">Miley</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">M.Z.</span> <span class="nlm-surname">Memon</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Y.M.</span> <span class="nlm-surname">Mohammad</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">G.A.</span> <span class="nlm-surname">Christoforidis</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Tariq</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">A.I.</span> <span class="nlm-surname">Qureshi</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">454-458; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2006 </span></div>
  
  
  
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