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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="citation_reference" content="citation_journal_title=Journal of the American College of Cardiology;citation_journal_abbrev=J Am Coll Cardiol;citation_author=I. Morishima;citation_author=T. Sone;citation_author=K. Okumura;citation_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;citation_pages=1202-1209;citation_volume=36;citation_year=2000;citation_issue=4;citation_issn=0735-1097;citation_pmid=11028471;citation_doi=10.1016/S0735-1097(00)00865-2" />
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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-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>
  
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    	<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. 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                  <em>Online Table 1:</em>  Methodology of the source studies
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                  <em>Online Table 3:</em>  Compilation and patient selection for the current analysis 
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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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