TY - JOUR
T1 - Predictors of response to endovascular treatment of posterior circulation stroke
AU - Gramegna, Laura Ludovica
AU - Requena, Manuel
AU - Dinia, Lavinia
AU - Melendez, Fernando
AU - Hernández, David
AU - Coscojuela, Pilar
AU - Quintana, Manuel
AU - Vert, Carla
AU - Rubiera, Marta
AU - Ribò, Marc
AU - Rovira, Àlex
AU - Molina, Carlos
AU - Tomasello, Alejandro
PY - 2019/7/1
Y1 - 2019/7/1
N2 - © 2019 Background: Endovascular treatment is considered a reasonable approach for patients with acute posterior circulation stroke, but it remains uncertain which patients will benefit the most from it. Objective: To find independent clinical and angiographic predictors of outcome after endovascular treatment for posterior circulation stroke. Methods: We evaluated consecutive patients with acute posterior circulation stroke who underwent endovascular treatment in our comprehensive stroke center from January 2015 to December 2017. Good outcome was defined as a modified Rankin score of 0–3 at 90 days. Intracranial atheromatous disease was established on focal stenosis recorded during endovascular treatment. Associations were sought between a good outcome and clinical and angiographic factors. Adjusted logistic regression models were used to define independent outcome predictors. Results: Forty-seven consecutive patients were included: mean age 70.9 ± 12.1 years, median admission NIHSS score, 16 (IQR: 8–30). On univariate analysis, age (p = 0.01), smoking (p = 0.04), hypertension (p = 0.03), successful reperfusion (p = 0.04), presence of extracranial atherosclerosis (p = 0.02), and absence of atherosclerosis (p = 0.03) were significantly associated with a good outcome. On multivariate analysis, age <70 years (odds ratio = 6.20, 95%CI 1.52–25.47, p = 0.01) and absence of intracranial atherosclerosis (odds ratio = 6.45, 95% CI 1.09–38.24, p = 0.04) were independently associated with a good outcome. Conclusions: Pretreatment determination of the presence or absence of intracranial atherosclerosis can aid management of posterior circulation stroke patients. The absence of intracranial atherosclerosis may have value as a positive selection criterion for endovascular treatment in future trials. The presence of intracranial atherosclerosis could be used as a selection tool in future studies investigating new treatment protocols for this population.
AB - © 2019 Background: Endovascular treatment is considered a reasonable approach for patients with acute posterior circulation stroke, but it remains uncertain which patients will benefit the most from it. Objective: To find independent clinical and angiographic predictors of outcome after endovascular treatment for posterior circulation stroke. Methods: We evaluated consecutive patients with acute posterior circulation stroke who underwent endovascular treatment in our comprehensive stroke center from January 2015 to December 2017. Good outcome was defined as a modified Rankin score of 0–3 at 90 days. Intracranial atheromatous disease was established on focal stenosis recorded during endovascular treatment. Associations were sought between a good outcome and clinical and angiographic factors. Adjusted logistic regression models were used to define independent outcome predictors. Results: Forty-seven consecutive patients were included: mean age 70.9 ± 12.1 years, median admission NIHSS score, 16 (IQR: 8–30). On univariate analysis, age (p = 0.01), smoking (p = 0.04), hypertension (p = 0.03), successful reperfusion (p = 0.04), presence of extracranial atherosclerosis (p = 0.02), and absence of atherosclerosis (p = 0.03) were significantly associated with a good outcome. On multivariate analysis, age <70 years (odds ratio = 6.20, 95%CI 1.52–25.47, p = 0.01) and absence of intracranial atherosclerosis (odds ratio = 6.45, 95% CI 1.09–38.24, p = 0.04) were independently associated with a good outcome. Conclusions: Pretreatment determination of the presence or absence of intracranial atherosclerosis can aid management of posterior circulation stroke patients. The absence of intracranial atherosclerosis may have value as a positive selection criterion for endovascular treatment in future trials. The presence of intracranial atherosclerosis could be used as a selection tool in future studies investigating new treatment protocols for this population.
KW - Endovascular treatment
KW - Intracranial atherosclerosis
KW - Posterior circulation stroke
U2 - 10.1016/j.ejrad.2019.05.001
DO - 10.1016/j.ejrad.2019.05.001
M3 - Article
C2 - 31153569
VL - 116
SP - 219
EP - 224
JO - European Journal of Radiology
JF - European Journal of Radiology
SN - 0720-048X
ER -