title: Comparison of the response to endovascular reperfusion in relation to site of arterial occlusion.
abstract: OBJECTIVE
  We explored the relationship between the site of vascular occlusion and the response to endovascular treatment in patients with acute ischemic stroke and also considered the impact of mismatch profile.
  
  
  METHODS
  DEFUSE-2 was a prospective cohort study of patients treated with endovascular therapy. Patients with internal carotid artery (ICA) and middle cerebral artery (MCA) involvement were included in this substudy. Mismatch and reperfusion status was assessed on MRI. Favorable clinical response was defined as an improvement of at least 8 points on the NIH Stroke Scale.
  
  
  RESULTS
  Reperfusion rates were comparable in both groups (61% for ICA and 59% for MCA). In the setting of reperfusion, percentages of favorable clinical response were similar between patients with stroke due to ICA (65%) and MCA (63%) occlusions. When reperfusion was not achieved, favorable outcomes were less frequent with obstructions of the ICA (9%) than the MCA (52%). Among target mismatch patients, the adjusted odds ratio for favorable clinical response associated with reperfusion was 39.7 (95% confidence interval 1.4-1,132.8) for ICA occlusions vs 5.1 (95% confidence interval 1.4-19.3) for MCA occlusions.
  
  
  CONCLUSIONS
  Endovascular reperfusion is associated with favorable clinical response regardless of the location of the arterial occlusion. This association is strongest for target mismatch patients with ICA occlusions. Target mismatch patients with either ICA or MCA occlusions appear to be good candidates for endovascular reperfusion therapy.
authors.affiliation: Stanford Stroke Center, Stanford University of Medicine, Stanford, CA, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Lemmens
authors.forename: Michael
authors.initials: M
authors.lastname: Mlynash
authors.forename: Matus
authors.initials: M
authors.lastname: Straka
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kemp
authors.forename: Roland
authors.initials: R
authors.lastname: Bammer
authors.forename: Michael P
authors.initials: MP
authors.lastname: Marks
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Lansberg
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000473:pathology / Q000601:surgery*; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002343:Carotid Artery, Internal / Q000473:pathology*; D015331:Cohort Studies; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D020768:Middle Cerebral Artery / Q000473:pathology*; D020127:Recovery of Function; D015424:Reperfusion; D020521:Stroke / Q000601:surgery*