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PT  - JOURNAL ARTICLE
AU  - Janjua, N.
AU  - Alkawi, A.
AU  - Suri, M.F.K.
AU  - Qureshi, A.I.
TI  - Impact of Arterial Reocclusion and Distal Fragmentation during Thrombolysis among Patients with Acute Ischemic Stroke
AID  - 10.3174/ajnr.A0825
DP  - 2008 Feb 01
TA  - American Journal of Neuroradiology
PG  - 253--258
VI  - 29
IP  - 2
4099  - http://www.ajnr.org/content/29/2/253.short
4100  - http://www.ajnr.org/content/29/2/253.full
SO  - Am. J. Neuroradiol.2008 Feb 01; 29
AB  - BACKGROUND AND PURPOSE: Arterial reocclusion and distal embolization are known complications of ischemic stroke intervention, impacting treatment strategies and device design. We sought to determine their rates of occurrence and effects on long-term outcomes during endovascular treatment of patients with acute ischemic stroke.MATERIALS AND METHODS: Retrospective analysis of data from 4 prospective acute stroke protocols was performed. Patients underwent the standard technique for parent vessel angiography followed by pharmacologic thrombolysis and/or sonographic thrombolysis and/or mechanical thrombus disruption. Certain patients also received systemic heparin or abciximab therapy. Demographic, clinical, and angiographic variables were assessed at onset, 24 hours, 1 week, and 1–3 months after the event. “Distal embolization” was defined qualitatively as appearance of an occlusion on a downstream vessel. “Arterial reocclusion” was defined as subsequent reocclusion of the target vessel after initial recanalization had been achieved.RESULTS: Arterial reocclusion occurred in 18% of these patients, whereas distal embolization occurred in 16% of the 91 patients treated in these protocols. Arterial reocclusion, but not distal embolization, was associated with a lower likelihood of favorable outcome at 1–3 months (P = .05; odds ratio, 3.9; 95% confidence interval, 0.01–0.98) after adjusting for age, initial National Institutes of Health Stroke Scale scores, sex, time to treatment, initial angiographic grade, symptomatic intracranial hemorrhage, and final recanalization.CONCLUSIONS: Arterial reocclusion and distal embolization occur in 16%–18% of patients with stroke undergoing endovascular intervention. Only arterial reocclusion is associated with poor long-term outcome. Prospective studies are needed to identify risk factors for their occurrence and possible preventive therapies.