title: Endovascular Treatment in Patients with Persistent Internal Carotid Artery Occlusion after Intravenous Tissue Plasminogen Activator: A Clinical Effectiveness Study.
abstract: There has been no large-scale trial comparing endovascular treatment (add-on EVT) after intravenous tissue plasminogen activator (IV tPA) and IV tPA alone in acute ischemic stroke (AIS) caused by internal carotid artery occlusion (ICAO). We aimed at investigating the effectiveness and safety of add-on EVT after IV tPA in AIS patients with ICAO.
  
  
  
  Between March 2010 and March 2013, 3,689 consecutive ischemic stroke patients who were hospitalized within 4.5 h of onset were identified using a prospective stroke registry at 11 centers in Korea. Among them, patients with persistent ICAO after receiving IV tPA and whose 3-month modified Rankin Scale (mRS) was available were finally enrolled. A propensity score analysis with inverse-probability of treatment weighting was used to eliminate baseline imbalances between those receiving add-on EVT and IV tPA alone.
  
  
  
  Among 264 patients enrolled in this study (mean age 71.4; male 56.4%; median National Institute of Health Stroke Scale score 15), 117 (44.3%) received add-on EVT. The add-on EVT group had a higher frequency of favorable outcome on the mRS ≤2 (35.0 vs. 18.4%; adjusted OR (aOR) 2.79; 95% CI 1.66-4.67) and lower mortality (17.9 vs. 35.4%; aOR 0.24; 95% CI 0.13-0.42) at 3 months, when compared to the IV tPA-alone group. Add-on EVT did not significantly increase the risk of symptomatic hemorrhage (5.1 vs. 4.1%; aOR 1.01; 95% CI 0.37-2.70). The rate of successful recanalization (thrombolysis in cerebral infarction grade ≥2b) in the add-on EVT group was 69.2%.
  
  
  
  Compared to an IV tPA alone, add-on EVT can improve clinical outcomes in patients with symptomatic ICAO within 4.5 h of onset without a significant increase of symptomatic hemorrhage.
authors.affiliation: Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
authors.forename: Jeong-Ho
authors.initials: JH
authors.lastname: Hong
authors.forename: Sung-Il
authors.initials: SI
authors.lastname: Sohn
authors.forename: Jihoon
authors.initials: J
authors.lastname: Kang
authors.forename: Min Uk
authors.initials: MU
authors.lastname: Jang
authors.forename: Beom Joon
authors.initials: BJ
authors.lastname: Kim
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.forename: Tai Hwan
authors.initials: TH
authors.lastname: Park
authors.forename: Sang-Soon
authors.initials: SS
authors.lastname: Park
authors.forename: Kyung Bok
authors.initials: KB
authors.lastname: Lee
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Lee
authors.forename: Kyung-Ho
authors.initials: KH
authors.lastname: Yu
authors.forename: Mi Sun
authors.initials: MS
authors.lastname: Oh
authors.forename: Jae Kwan
authors.initials: JK
authors.lastname: Cha
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Kim
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.forename: Soo Joo
authors.initials: SJ
authors.lastname: Lee
authors.forename: Youngchai
authors.initials: Y
authors.lastname: Ko
authors.forename: Jae Guk
authors.initials: JG
authors.lastname: Kim
authors.forename: Jong-Moo
authors.initials: JM
authors.lastname: Park
authors.forename: Kyusik
authors.initials: K
authors.lastname: Kang
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Cho
authors.forename: Keun-Sik
authors.initials: KS
authors.lastname: Hong
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Cho
authors.forename: Joon-Tae
authors.initials: JT
authors.lastname: Kim
authors.forename: Jay Chol
authors.initials: JC
authors.lastname: Choi
authors.forename: Juneyoung
authors.initials: J
authors.lastname: Lee
authors.forename: Ji-Sung
authors.initials: JS
authors.lastname: Lee
authors.forename: Philip B
authors.initials: PB
authors.lastname: Gorelick
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057216:Propensity Score; D012039:Regional Blood Flow; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator