title: Vessel Patency at 24 Hours and Its Relationship With Clinical Outcomes and Infarct Volume in REVASCAT Trial (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset).
abstract: Higher rates of target vessel patency at 24 hours were noted in the thrombectomy group compared with control group in recent randomized trials. As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as they related to clinical outcome and 24-hour infarct volume in REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset).
  
  
  
  Independent core laboratory adjudicated vessel status according to modified arterial occlusive lesion classification at 24 hours on computed tomographic/magnetic resonance (94.2%/5.8%) angiography and 24-hour infarct volume on computed tomography were studied (95/103 patients in the thrombectomy group versus 94/103 in the control group, respectively). Complete revascularization was defined as modified arterial occlusive lesion grade 3. Its effect on clinical outcome was analyzed by ordinal logistic regression.
  
  
  
  Complete revascularization was achieved in 70.5% of the solitaire group and in 22.3% of the control group (P<0.001). Significant differences in complete revascularization rates were found for terminus internal carotid artery, M1, and tandem occlusions (allP<0.001) but not for M2 occlusions. In the thrombectomy group, 2 out of 63 patients (3.1%) with modified Thrombolysis in Cerebral Infarction 2b/3 after thrombectomy showed arterial reocclusion (modified arterial occlusive lesion grade 0/1) at 24 hours. Complete revascularization was associated with improved outcome in both thrombectomy (adjusted odds ratio, 4.5; 95% confidence interval, 1.9-10.9) and control groups (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-6.7). Revascularization (modified arterial occlusive lesion grade 2/3) was associated with smaller infarct volumes in either treatment arm.
  
  
  
  Complete revascularization at 24 hours is a powerful predictor of favorable clinical outcome, whereas revascularization of any type results in reduced infarct volume in both thrombectomy and control groups.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01692379.
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.). mmillan.germanstrias@gencat.cat.
authors.forename: Mònica
authors.initials: M
authors.lastname: Millán
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Sebastià
authors.initials: S
authors.lastname: Remollo
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Helena
authors.initials: H
authors.lastname: Quesada
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Arturo
authors.initials: A
authors.lastname: Renú
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Alejandro
authors.initials: A
authors.lastname: Tomasello
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Priyanka
authors.initials: P
authors.lastname: Minhas
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Natalia
authors.initials: N
authors.lastname: Pérez de la Ossa
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Marta
authors.initials: M
authors.lastname: Rubiera
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Laura
authors.initials: L
authors.lastname: Llull
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Pedro
authors.initials: P
authors.lastname: Cardona
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Fahad
authors.initials: F
authors.lastname: Al-Ajlan
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: María
authors.initials: M
authors.lastname: Hernández
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Zarina
authors.initials: Z
authors.lastname: Assis
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
authors.affiliation: From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (H.Q., P.C.); Stroke Unit, Neurology Department, Hospital Clínic, Barcelona, Spain (A.R., L.L.); Radiology Department (A.T.) and Stroke Unit, Neurology Department (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Calgary Stroke Program, Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary (P.M., F.A.-A., Z.A., A.M.D.); and Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.).
authors.forename: Antoni
authors.initials: A
authors.lastname: Dávalos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D020520:Brain Infarction / Q000000981:diagnostic imaging* / Q000209:etiology; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D002560:Cerebrovascular Circulation; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017131:Thrombectomy / Q000379:methods*; D013997:Time Factors
keywords: angiography; computed tomographic angiography; magnetic resonance angiography; reocclusion; stroke; thrombectomy