Impact of arterial reocclusion and distal fragmentation during thrombolysis among patients with acute ischemic stroke.
OBJECTIVE
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.


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.
Janjua
N
N
Department of Neurology, Long Island College Hospital and State University of New York Health Science Center at Brooklyn, Brooklyn, NY 11201, USA. NJanjua@chpnet.org
Alkawi
A
A
Suri
M F K
MF
Qureshi
A I
AI
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D016893:Carotid Stenosis / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome
D005343:Fibrinolytic Agents