RT Journal Article
SR Electronic
T1 Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 142
OP 147
DO 10.1136/neurintsurg-2019-014935
VO 12
IS 2
A1 Nitin Goyal
A1 Georgios Tsivgoulis
A1 Jason J Chang
A1 Konark Malhotra
A1 Juan Goyanes
A1 Abhi Pandhi
A1 Rashi Krishnan
A1 Muhammad F Ishfaq
A1 Daniel Hoit
A1 Christopher Nickele
A1 Violiza Inoa-Acosta
A1 Aristeidis H Katsanos
A1 Lucas Elijovich
A1 Andrei Alexandrov
A1 Adam S Arthur
YR 2020
UL http://jnis.bmj.com/content/12/2/142.abstract
AB Introduction One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)).Objective To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT.Methods Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated.Results A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11–20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005).Conclusions IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT.