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Subacute Recanalization and Reocclusion in Patients with Acute Ischemic Stroke Following Endovascular Treatment

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Abstract

Objective

To determine the rate of subacute recanalization and reocclusion and its effect on clinical outcomes among patients with ischemic stroke treated with endovascular treatment. Subacute recanalization and reocclusion occurring hours after completion of the intravenous or intra-arterial thrombolysis for acute ischemic stroke has been reported in anecdotal cases.

Methods

We performed cerebral angiography at 24 h to determine the status of occlusion after endovascular treatment (compared with immediate post-procedure angiogram) in a series of patients with ischemic stroke treated with endovascular treatment. Clinical and radiological evaluations were performed before and 24 h, and prior to discharge or 1–3 months after treatment. We performed multivariate analysis to evaluate the effect of subacute recanalization on clinical outcome graded using modified Rankin scale (mRS). Favorable outcome was defined by mRS of 0–2.

Results

A total of 56 patients (mean age 66 ± 14 years; 22 were men) were analyzed. Subacute recanalization was observed in 16 (29%) patients and consisted of additional recanalization in 8 patients with early recanalization. Subacute recanalization was associated with a trend toward a higher rate of favorable outcome (Wald chi-square 3.3, P = 0.19) after adjusting for other covariates. Subacute recanalization was not associated with either neurological deterioration or symptomatic intracranial hemorrhage. Subacute reocclusion was observed in 5 (9%) patients. Subacute reocclusion was associated with a trend toward higher rate of neurological deterioration within 24 h (Wald chi-square 2.1, P = 0.15) after adjusting for other covariates.

Conclusion

We found that new or additional recanalization occurs in one-fourth of the patients within 24 h of endovascular treatment and is not associated with any adverse consequences. Subacute reocclusion occurs infrequently after endovascular treatment.

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References

  1. Qureshi AI, Siddiqui AM, Kim SH, et al. Reocclusion of recanalized arteries during intra-arterial thrombolysis for acute ischemic stroke. AJNR Am J Neuroradiol. 2004;25(2):322–8.

    PubMed  Google Scholar 

  2. Janjua N, Alkawi A, Suri MF, et al. Impact of arterial reocclusion and distal fragmentation during thrombolysis among patients with acute ischemic stroke. AJNR Am J Neuroradiol. 2008;29:253–8.

    Article  PubMed  CAS  Google Scholar 

  3. Qureshi AI, Suri MFK, Ali Z, et al. Intraarterial reteplase and intravenous abciximab for treatment of acute ischemic stroke. A preliminary feasibility and safety study in a non-human primate model. Neuroradiology. 2005;47(11):845–54. doi:10.1007/s00234-003-1097-7.

    Article  PubMed  Google Scholar 

  4. Molina CA, Alvarez-Sabin J, Montaner J, et al. Thrombolysis-related hemorrhagic infarction: a marker of early reperfusion, reduced infarct size, and improved outcome in patients with proximal middle cerebral artery occlusion. Stroke. 2002;33(6):1551–6 [see comment]. doi:10.1161/01.STR.0000016323.13456.E5.

    Google Scholar 

  5. Humpich M, Singer OC, du Mesnil de Rochemont R, et al. Effect of early and delayed recanalization on infarct pattern in proximal middle cerebral artery occlusion. Cerebrovasc Dis. 2006;22(1):51–6. doi:10.1159/000092338.

    Article  PubMed  Google Scholar 

  6. Alvarez-Sabin J, Molina CA, Ribo M, et al. Impact of admission hyperglycemia on stroke outcome after thrombolysis: risk stratification in relation to time to reperfusion. Stroke. 2004;35(11):2493–8 [see comment]. doi:10.1161/01.STR.0000143728.45516.c6.

    Article  PubMed  Google Scholar 

  7. Adams HP Jr, del Zoppo G, Alberts MJ, et al. 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. Stroke. 2007;38(5):1655–711. doi:10.1161/STROKEAHA.107.181486.

    Google Scholar 

  8. Qureshi AI, Janjua N, Kirmani JF, et al. Mechanical disruption of thrombus following intravenous tissue plasminogen activator for ischemic stroke. J Neuroimaging. 2007;17(2):124–30.

    PubMed  Google Scholar 

  9. Furlan A, Higashida R, Wechsler L, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA. 1999;282(21):2003–11 [see comment]. doi:10.1001/jama.282.21.2003.

  10. Prosser J, Butcher K, Allport L, et al. Clinical-diffusion mismatch predicts the putative penumbra with high specificity. Stroke. 2005;36(8):1700–4. doi:10.1161/01.STR.0000173407.40773.17.

    Article  PubMed  Google Scholar 

  11. Katzan IL, Masaryk TJ, Furlan AJ, et al. Intra-arterial thrombolysis for perioperative stroke after open heart surgery. Neurology. 1999;52(5):1081–4.

    PubMed  CAS  Google Scholar 

  12. Qureshi AI, Ali Z, Suri MF, et al. Intra-arterial third-generation recombinant tissue plasminogen activator (reteplase) for acute ischemic stroke. Neurosurgery. 2001;49(1):41–8; discussion 48–50. doi:10.1097/00006123-200107000-00006.

    Google Scholar 

  13. Qureshi AI, Siddiqui AM, Suri MFK, et al. Aggressive mechanical clot disruption and low-dose intra-arterial third-generation thrombolytic agent for ischemic stroke: a prospective study. Neurosurgery. 2002;51(5):1319–27; discussion 1327–1319. doi:10.1097/00006123-200211000-00040.

    Google Scholar 

  14. Qureshi AI, Hussein HM, Janjua N, et al. Postprocedure intravenous eptifibatide following intra-arterial reteplase in patients with acute ischemic stroke. J Neuroimaging. 2008;18(1):50–5.

    Article  PubMed  Google Scholar 

  15. Divani AA, Qureshi AI, Hoffman KR, et al. Comparison of asymmetry in cerebral blood flow between brain hemispheres using digital subtraction angiography. J Neuroimaging. 2006;16(2):139–45 [see comment].

    PubMed  Google Scholar 

  16. Schrader J, Luders S, Kulschewski A, et al. The ACCESS Study: evaluation of acute candesartan cilexetil therapy in stroke survivors. Stroke. 2003;34(7):1699–703 [see comment]. doi:10.1161/01.STR.0000075777.18006.89.

    Article  PubMed  Google Scholar 

  17. Qureshi AI. New grading system for angiographic evaluation of arterial occlusions and recanalization response to intra-arterial thrombolysis in acute ischemic stroke. Neurosurgery. 2002;50(6):1405–14; discussion 1414–1405. doi:10.1097/00006123-200206000-00049.

    Google Scholar 

  18. Qureshi AI. Endovascular treatment of cerebrovascular diseases and intracranial neoplasms. Lancet. 2004;363(9411):804–13. doi:10.1016/S0140-6736(04)15697-3.

    Article  PubMed  Google Scholar 

  19. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38(3):967–73 [see comment]. doi:10.1161/01.STR.0000258112.14918.24.

    Article  PubMed  Google Scholar 

  20. Higashida RT, Furlan AJ, Roberts H, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34(8):e109–37 [see comment]. Erratum appears in Stroke. 2003;34(11):2774. doi:10.1161/01.STR.0000082721.62796.09.

  21. Qureshi AI, Boulos AS, Hanel RA, et al. Randomized comparison of intra-arterial and intravenous thrombolysis in a canine model of acute basilar artery thrombosis. Neuroradiology. 2004;46(12):988–95. doi:10.1007/s00234-004-1180-8.

    Article  PubMed  CAS  Google Scholar 

  22. von Kummer R, Holle R, Rosin L, et al. Does arterial recanalization improve outcome in carotid territory stroke? Stroke. 1995;26(4):581–7.

    Google Scholar 

  23. Molina CA, Montaner J, Abilleira S, et al. Timing of spontaneous recanalization and risk of hemorrhagic transformation in acute cardioembolic stroke. Stroke. 2001;32(5):1079–84.

    PubMed  CAS  Google Scholar 

  24. Ribo M, Alvarez-Sabin J, Montaner J, et al. Temporal profile of recanalization after intravenous tissue plasminogen activator: selecting patients for rescue reperfusion techniques. Stroke. 2006;37(4):1000–4. doi:10.1161/01.STR.0000206443.96112.d9.

    Article  PubMed  CAS  Google Scholar 

  25. Wunderlich MT, Goertler M, Postert T, et al. Recanalization after intravenous thrombolysis: does a recanalization time window exist? Neurology. 2007;68(17):1364–8 [see comment]. doi:10.1212/01.wnl.0000260604.26469.8e.

    Article  PubMed  CAS  Google Scholar 

  26. Qureshi AI, Pande RU, Kim SH, et al. Third generation thrombolytics for the treatment of ischemic stroke. Curr Opin Investig Drugs. 2002;3(12):1729–32.

    PubMed  CAS  Google Scholar 

  27. Mattsson C, Nilsson S, Haggroth L. Human extrinsic plasminogen activator fibrinolytic properties and neutralization in vivo. Thromb Res. 1983;30(1):91–100. doi:10.1016/0049-3848(83)90400-0.

    Article  PubMed  CAS  Google Scholar 

  28. Nesheim M, Fredenburgh JC, Larsen GR. The dissociation constants and stoichiometries of the interactions of Lys-plasminogen and chloromethyl ketone derivatives of tissue plasminogen activator and the variant delta FEIX with intact fibrin. J Biol Chem. 1990;265(35):21541–8.

    PubMed  CAS  Google Scholar 

  29. Torr SR, Nachowiak DA, Fujii S, et al. “Plasminogen steal” and clot lysis. J Am Coll Cardiol. 1992;19(5):1085–90.

    Article  PubMed  CAS  Google Scholar 

  30. Sakharov DV, Rijken DC. The effect of flow on lysis of plasma clots in a plasma environment. Thromb Haemost. 2000;83(3):469–74.

    PubMed  CAS  Google Scholar 

  31. Torr SR, Eisenberg PR, Sobel BE. The dependence of activation of platelets by a plasminogen activator on the evolution of thrombin activity. Thromb Res. 1991;64(4):435–44. doi:10.1016/0049-3848(91)90344-V.

    Article  PubMed  CAS  Google Scholar 

  32. Qureshi AI, Luft AR, Sharma M, et al. Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: part I—pathophysiological and pharmacological features. Neurosurgery. 2000;46(6):1344–59. doi:10.1097/00006123-200006000-00012.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, Minneapolis, MN, 55455, USA

    Adnan I. Qureshi, Haitham M. Hussein & Alexandros L. Georgiadis

  2. Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA

    Mohamed Abdelmoula

  3. Department of Neurology, Long Island College Hospital, Brooklyn, NY, USA

    Nazli Janjua

  4. State University of New York Health Sciences Center, Downstate Campus, Brooklyn, NY, USA

    Nazli Janjua

Authors
  1. Adnan I. Qureshi
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  2. Haitham M. Hussein
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  3. Mohamed Abdelmoula
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  4. Alexandros L. Georgiadis
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  5. Nazli Janjua
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Correspondence to Adnan I. Qureshi.

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Qureshi, A.I., Hussein, H.M., Abdelmoula, M. et al. Subacute Recanalization and Reocclusion in Patients with Acute Ischemic Stroke Following Endovascular Treatment. Neurocrit Care 10, 195–203 (2009). https://doi.org/10.1007/s12028-008-9161-0

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  • DOI: https://doi.org/10.1007/s12028-008-9161-0

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