Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy

Nitin Goyal, Georgios Tsivgoulis, Jason J. Chang, Konark Malhotra, Juan Goyanes, Abhi Pandhi, Rashi Krishnan, Muhammad F. Ishfaq, Daniel Hoit, Christopher Nickele, Violiza Inoa-Acosta, Aristeidis H. Katsanos, Lucas Elijovich, Andrei Alexandrov, Adam Arthur

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Abstract

Introduction: One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)). Objective: To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT. Methods: Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated. Results: A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11-20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005). Conclusions: IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT.

Original languageEnglish (US)
JournalJournal of neurointerventional surgery
DOIs
StatePublished - Jan 1 2019

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Thrombectomy
Hong Kong
Stroke
Mechanical Thrombolysis
Logistic Models
National Institutes of Health (U.S.)

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy. / Goyal, Nitin; Tsivgoulis, Georgios; Chang, Jason J.; Malhotra, Konark; Goyanes, Juan; Pandhi, Abhi; Krishnan, Rashi; Ishfaq, Muhammad F.; Hoit, Daniel; Nickele, Christopher; Inoa-Acosta, Violiza; Katsanos, Aristeidis H.; Elijovich, Lucas; Alexandrov, Andrei; Arthur, Adam.

In: Journal of neurointerventional surgery, 01.01.2019.

Research output: Contribution to journalArticle

Goyal, Nitin ; Tsivgoulis, Georgios ; Chang, Jason J. ; Malhotra, Konark ; Goyanes, Juan ; Pandhi, Abhi ; Krishnan, Rashi ; Ishfaq, Muhammad F. ; Hoit, Daniel ; Nickele, Christopher ; Inoa-Acosta, Violiza ; Katsanos, Aristeidis H. ; Elijovich, Lucas ; Alexandrov, Andrei ; Arthur, Adam. / Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy. In: Journal of neurointerventional surgery. 2019.
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title = "Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy",
abstract = "Introduction: One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)). Objective: To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT. Methods: Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated. Results: A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50{\%} men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11-20), 69{\%} pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10{\%} vs 20{\%}; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28{\%} vs 10{\%}, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30{\%} vs 50{\%}; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95{\%} CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95{\%} CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95{\%} CI 1.43 to 7.69; p=0.005). Conclusions: IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT.",
author = "Nitin Goyal and Georgios Tsivgoulis and Chang, {Jason J.} and Konark Malhotra and Juan Goyanes and Abhi Pandhi and Rashi Krishnan and Ishfaq, {Muhammad F.} and Daniel Hoit and Christopher Nickele and Violiza Inoa-Acosta and Katsanos, {Aristeidis H.} and Lucas Elijovich and Andrei Alexandrov and Adam Arthur",
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T1 - Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy

AU - Goyal, Nitin

AU - Tsivgoulis, Georgios

AU - Chang, Jason J.

AU - Malhotra, Konark

AU - Goyanes, Juan

AU - Pandhi, Abhi

AU - Krishnan, Rashi

AU - Ishfaq, Muhammad F.

AU - Hoit, Daniel

AU - Nickele, Christopher

AU - Inoa-Acosta, Violiza

AU - Katsanos, Aristeidis H.

AU - Elijovich, Lucas

AU - Alexandrov, Andrei

AU - Arthur, Adam

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)). Objective: To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT. Methods: Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated. Results: A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11-20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005). Conclusions: IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT.

AB - Introduction: One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)). Objective: To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT. Methods: Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated. Results: A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11-20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005). Conclusions: IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT.

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U2 - 10.1136/neurintsurg-2019-014935

DO - 10.1136/neurintsurg-2019-014935

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