Failure of complete recanalization is associated with poor outcome after cardioembolic stroke

H. S. Nam, K. Y. Lee, Y. D. Kim, H. Y. Choi, H. J. Cho, M. J. Cha, C. M. Nam, Jihoe Heo

Research output: Contribution to journalArticle

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Abstract

Background: Recanalization is strongly associated with outcomes after thrombolytic treatment. Cardiac emboli are known as better response to fibrinolytic agents because they are fibrin-rich; however, cardioembolic stroke itself is associated with poor outcomes and high mortality. Completeness of recanalization may therefore affect the outcome of cardioembolic stroke. We investigated whether degree of recanalization influences outcomes following fibrinolytic therapy in cardioembolic stroke. Methods: Consecutive stroke patients with relevant artery occlusions on baseline CT angiography who had received thrombolytic treatment were enrolled. Completeness of recanalization was assessed by the Thrombolysis in Myocardial Infarction (TIMI) grade, which was compared between patients with and without cardiac sources of embolism (CSE). We also investigated independent predictors of poor outcome (modified Rankin scale score 3-6) at 3months. Results: Of the 127 patients enrolled, 65 (51%) had one or more CSE. Although the overall recanalization rates (TIMI 2 or 3) in patients with CSE (65%) and patients without CSE (68%) were similar (P=0.710), patients with CSE were less likely to show complete recanalization (TIMI 3) compared with those without CSE (19% vs. 39%, P=0.011). Multivariate analysis revealed that CSE was associated with failure of complete recanalization (OR 2.809, 95% CI 1.097-7.192) and was an independent predictor of poor outcome at 3months (OR 3.629, 95% CI 1.205-8.869). Conclusions: In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis.

Original languageEnglish
Pages (from-to)1171-1178
Number of pages8
JournalEuropean Journal of Neurology
Volume18
Issue number9
DOIs
Publication statusPublished - 2011 Sep 1

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Embolism
Stroke
Thrombolytic Therapy
Myocardial Infarction
Fibrinolytic Agents
Fibrin
Multivariate Analysis
Arteries
Mortality
Therapeutics

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Nam, H. S. ; Lee, K. Y. ; Kim, Y. D. ; Choi, H. Y. ; Cho, H. J. ; Cha, M. J. ; Nam, C. M. ; Heo, Jihoe. / Failure of complete recanalization is associated with poor outcome after cardioembolic stroke. In: European Journal of Neurology. 2011 ; Vol. 18, No. 9. pp. 1171-1178.
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abstract = "Background: Recanalization is strongly associated with outcomes after thrombolytic treatment. Cardiac emboli are known as better response to fibrinolytic agents because they are fibrin-rich; however, cardioembolic stroke itself is associated with poor outcomes and high mortality. Completeness of recanalization may therefore affect the outcome of cardioembolic stroke. We investigated whether degree of recanalization influences outcomes following fibrinolytic therapy in cardioembolic stroke. Methods: Consecutive stroke patients with relevant artery occlusions on baseline CT angiography who had received thrombolytic treatment were enrolled. Completeness of recanalization was assessed by the Thrombolysis in Myocardial Infarction (TIMI) grade, which was compared between patients with and without cardiac sources of embolism (CSE). We also investigated independent predictors of poor outcome (modified Rankin scale score 3-6) at 3months. Results: Of the 127 patients enrolled, 65 (51{\%}) had one or more CSE. Although the overall recanalization rates (TIMI 2 or 3) in patients with CSE (65{\%}) and patients without CSE (68{\%}) were similar (P=0.710), patients with CSE were less likely to show complete recanalization (TIMI 3) compared with those without CSE (19{\%} vs. 39{\%}, P=0.011). Multivariate analysis revealed that CSE was associated with failure of complete recanalization (OR 2.809, 95{\%} CI 1.097-7.192) and was an independent predictor of poor outcome at 3months (OR 3.629, 95{\%} CI 1.205-8.869). Conclusions: In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis.",
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Failure of complete recanalization is associated with poor outcome after cardioembolic stroke. / Nam, H. S.; Lee, K. Y.; Kim, Y. D.; Choi, H. Y.; Cho, H. J.; Cha, M. J.; Nam, C. M.; Heo, Jihoe.

In: European Journal of Neurology, Vol. 18, No. 9, 01.09.2011, p. 1171-1178.

Research output: Contribution to journalArticle

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T1 - Failure of complete recanalization is associated with poor outcome after cardioembolic stroke

AU - Nam, H. S.

AU - Lee, K. Y.

AU - Kim, Y. D.

AU - Choi, H. Y.

AU - Cho, H. J.

AU - Cha, M. J.

AU - Nam, C. M.

AU - Heo, Jihoe

PY - 2011/9/1

Y1 - 2011/9/1

N2 - Background: Recanalization is strongly associated with outcomes after thrombolytic treatment. Cardiac emboli are known as better response to fibrinolytic agents because they are fibrin-rich; however, cardioembolic stroke itself is associated with poor outcomes and high mortality. Completeness of recanalization may therefore affect the outcome of cardioembolic stroke. We investigated whether degree of recanalization influences outcomes following fibrinolytic therapy in cardioembolic stroke. Methods: Consecutive stroke patients with relevant artery occlusions on baseline CT angiography who had received thrombolytic treatment were enrolled. Completeness of recanalization was assessed by the Thrombolysis in Myocardial Infarction (TIMI) grade, which was compared between patients with and without cardiac sources of embolism (CSE). We also investigated independent predictors of poor outcome (modified Rankin scale score 3-6) at 3months. Results: Of the 127 patients enrolled, 65 (51%) had one or more CSE. Although the overall recanalization rates (TIMI 2 or 3) in patients with CSE (65%) and patients without CSE (68%) were similar (P=0.710), patients with CSE were less likely to show complete recanalization (TIMI 3) compared with those without CSE (19% vs. 39%, P=0.011). Multivariate analysis revealed that CSE was associated with failure of complete recanalization (OR 2.809, 95% CI 1.097-7.192) and was an independent predictor of poor outcome at 3months (OR 3.629, 95% CI 1.205-8.869). Conclusions: In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis.

AB - Background: Recanalization is strongly associated with outcomes after thrombolytic treatment. Cardiac emboli are known as better response to fibrinolytic agents because they are fibrin-rich; however, cardioembolic stroke itself is associated with poor outcomes and high mortality. Completeness of recanalization may therefore affect the outcome of cardioembolic stroke. We investigated whether degree of recanalization influences outcomes following fibrinolytic therapy in cardioembolic stroke. Methods: Consecutive stroke patients with relevant artery occlusions on baseline CT angiography who had received thrombolytic treatment were enrolled. Completeness of recanalization was assessed by the Thrombolysis in Myocardial Infarction (TIMI) grade, which was compared between patients with and without cardiac sources of embolism (CSE). We also investigated independent predictors of poor outcome (modified Rankin scale score 3-6) at 3months. Results: Of the 127 patients enrolled, 65 (51%) had one or more CSE. Although the overall recanalization rates (TIMI 2 or 3) in patients with CSE (65%) and patients without CSE (68%) were similar (P=0.710), patients with CSE were less likely to show complete recanalization (TIMI 3) compared with those without CSE (19% vs. 39%, P=0.011). Multivariate analysis revealed that CSE was associated with failure of complete recanalization (OR 2.809, 95% CI 1.097-7.192) and was an independent predictor of poor outcome at 3months (OR 3.629, 95% CI 1.205-8.869). Conclusions: In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis.

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