title: Current status of recanalization therapy in acute ischemic stroke with symptomatic intracranial arterial occlusion in Korea.
abstract: BACKGROUND
  Recent methodological advances in recanalization therapy may alter recanalization strategies and clinical outcomes in patients with symptomatic occlusion of intracranial cerebral arteries. However, few studies have analyzed these changes at a national level, with none conducted in Korea.
  
  
  METHODS
  On the basis of a prospective multicenter stroke registry database in Korea, 642 consecutive patients hospitalized within 12 hours of the onset with symptomatic occlusion of intracranial major cerebral arteries between March 2010 and November 2011 were identified. Recanalization therapy was used in 48% (n = 307) of patients; intravenous thrombolysis only (IVT) in 46%, intra-arterial thrombolysis only (IAT) in 16%, and combined thrombolysis (CMT) in 38%. Of the 166 patients treated by IAT or CMT, the Penumbra system or the Solitaire was used in 58% of patients.
  
  
  RESULTS
  Early neurologic improvement (ENI), 3-month modified Rankin scale (mRS) score of 2 or less, and symptomatic hemorrhagic transformation (SHT) were observed in 43%, 39%, and 9% of the patients in the IVT group; 52%, 27%, and 12% of the patients in the IAT group; and 54%, 39%, and 12% of the patients in the CMT group, respectively. Compared with no treatment, adjusted odd ratios (95% confidence intervals) of recanalization therapy were 1.59 (1.04-2.42) for ENI, 1.37 (.81-2.30) for 3-month mRS score of 2 or less, and 2.58 (1.12-5.91) for SHT.
  
  
  CONCLUSIONS
  The variety and active use of endovascular approaches were quite noticeable. As a whole, recanalization therapy tended to contribute to favorable outcomes despite a significant increase of symptomatic hemorrhage.
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon, Korea.
authors.forename: Min Uk
authors.initials: MU
authors.lastname: Jang
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jeong-Ho
authors.initials: JH
authors.lastname: Hong
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jihoon
authors.initials: J
authors.lastname: Kang
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Beom Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Lee
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Kyung-Ho
authors.initials: KH
authors.lastname: Yu
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Mi Sun
authors.initials: MS
authors.lastname: Oh
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea.
authors.forename: Keun-Sik
authors.initials: KS
authors.lastname: Hong
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Cho
authors.affiliation: Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Jong-Moo
authors.initials: JM
authors.lastname: Park
authors.affiliation: Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Kyusik
authors.initials: K
authors.lastname: Kang
authors.affiliation: Department of Neurology, Dong-A University Hospital, Pusan, Korea.
authors.forename: Jae Kwan
authors.initials: JK
authors.lastname: Cha
authors.affiliation: Department of Neurology, Dong-A University Hospital, Pusan, Korea.
authors.forename: Dae-Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul Medical Center, Seoul, Korea.
authors.forename: Tai Hwan
authors.initials: TH
authors.lastname: Park
authors.affiliation: Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Kyung Bok
authors.initials: KB
authors.lastname: Lee
authors.affiliation: Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Soo Joo
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Youngchai
authors.initials: Y
authors.lastname: Ko
authors.affiliation: Department of Neurology, Yeungnam University Medical Center, Daegu, Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Cho
authors.affiliation: Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Joon-Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
authors.forename: Juneyoung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Biostatistical Consulting Unit, Soonchunhyang University Medical Center of Biostatistics, Seoul, Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea. Electronic address: braindoc@snu.ac.kr.
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002539:Cerebral Arterial Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D004185:Disability Evaluation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000639:trends*; D020127:Recovery of Function; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000639:trends*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Korea; Recanalization therapy; acute ischemic stroke; endovascular treatment; intracranial arterial occlusion; outcome; registry; thrombolysis