Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke

Jeong Ho Hong; Jihoon Kang; Min Uk Jang; Beom Joon Kim; Moon Ku Han; Tai Hwan Park; Sang Soon Park; Kyung Bok Lee; Byung Chul Lee; Kyung Ho Yu; Mi Sun Oh; Jae Kwan Cha; Dae Hyun Kim; Jun Lee; Soo Joo Lee; Youngchai Ko; Jong Moo Park; Kyusik Kang; Yong Jin Cho; Keun Sik Hong; Ki Hyun Cho; Joon Tae Kim; Juneyoung Lee; Ji Sung Lee; Hee Joon Bae

doi:10.1016/j.jstrokecerebrovasdis.2014.04.025

Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke

Jeong Ho Hong, Jihoon Kang, Min Uk Jang, Beom Joon Kim, Moon Ku Han, Tai Hwan Park, Sang Soon Park, Kyung Bok Lee, Byung Chul Lee, Kyung Ho Yu, Mi Sun Oh, Jae Kwan Cha, Dae Hyun Kim, Jun Lee, Soo Joo Lee, Youngchai Ko, Jong Moo Park, Kyusik Kang, Yong Jin Cho, Keun Sik HongKi Hyun Cho, Joon Tae Kim, Juneyoung Lee, Ji Sung Lee, Hee Joon Bae

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

Abstract

Background We aimed to describe the current status and clinical outcomes of recanalization therapy for internal carotid artery occlusion (ICAO) presenting as acute ischemic stroke.

Methods Using a nationwide stroke registry database in Korea, we identified consecutive ischemic stroke patients with ICAO hospitalized within 12 hours of onset between March 2010 and November 2011.

Results ICAO accounted for 10.6% (322 of 3028) of acute ischemic strokes within 12 hours of onset. Among the 322 ICAO patients, 53% underwent recanalization therapy, 41% intravenous thrombolysis (IVT) alone, and 59% endovascular treatment (EVT). Twenty-two percent of those with mild deficits (National Institutes of Health Stroke Scale <4) and 50% of those 80 years of age or more received recanalization therapy. Compared with no treatment, recanalization therapy was not significantly associated with a favorable outcome (3-month modified Rankin scale, 0-2) (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI],.80-3.91; P =.16). However, compared with IVT, EVT significantly improved the odds of favorable outcome (OR, 2.86; 95% CI, 1.19-6.88; P =.02) without significant increase of symptomatic intracranial hemorrhage (OR, 2.18; 95% CI,.42-11.43; P =.36) and 3-month mortality (OR,.53; 95% CI,.23-1.18; P =.12). Successful recanalization rate (Thrombolysis in Cerebral Infarction <2a) by EVT was 76%.

Conclusions In Korea, one tenth of acute ischemic stroke was caused by ICAO, and about 50% were treated by recanalization therapy. EVT was widely used as a recanalization modality (about 60% of cases) despite lack of evidence. However, its effectiveness and safety were acceptable.

Original language	English
Pages (from-to)	2183-2189
Number of pages	7
Journal	Journal of Stroke and Cerebrovascular Diseases
Volume	23
Issue number	8
DOIs	https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.04.025
Publication status	Published - 2014 Sept 1
Externally published	Yes

Bibliographical note

Funding Information:
This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry of Health and Welfare, Republic of Korea . ( HI10C2020 ).

Publisher Copyright:
© 2014 National Stroke Association.

Keywords

Endovascular recanalization
acute stroke
carotid artery
revascularization
thrombolysis

ASJC Scopus subject areas

Surgery
Rehabilitation
Clinical Neurology
Cardiology and Cardiovascular Medicine

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10.1016/j.jstrokecerebrovasdis.2014.04.025

Cite this

Hong, J. H., Kang, J., Jang, M. U., Kim, B. J., Han, M. K., Park, T. H., Park, S. S., Lee, K. B., Lee, B. C., Yu, K. H., Oh, M. S., Cha, J. K., Kim, D. H., Lee, J., Lee, S. J., Ko, Y., Park, J. M., Kang, K., Cho, Y. J., ... Bae, H. J. (2014). Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases, 23(8), 2183-2189. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.04.025

Hong, JH, Kang, J, Jang, MU, Kim, BJ, Han, MK, Park, TH, Park, SS, Lee, KB, Lee, BC, Yu, KH, Oh, MS, Cha, JK, Kim, DH, Lee, J, Lee, SJ, Ko, Y, Park, JM, Kang, K, Cho, YJ, Hong, KS, Cho, KH, Kim, JT, Lee, J, Lee, JS & Bae, HJ 2014, 'Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke', Journal of Stroke and Cerebrovascular Diseases, vol. 23, no. 8, pp. 2183-2189. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.04.025

@article{daa6a34c82b544a6bef1cfef1265012f,

title = "Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke",

abstract = "Background We aimed to describe the current status and clinical outcomes of recanalization therapy for internal carotid artery occlusion (ICAO) presenting as acute ischemic stroke.Methods Using a nationwide stroke registry database in Korea, we identified consecutive ischemic stroke patients with ICAO hospitalized within 12 hours of onset between March 2010 and November 2011.Results ICAO accounted for 10.6% (322 of 3028) of acute ischemic strokes within 12 hours of onset. Among the 322 ICAO patients, 53% underwent recanalization therapy, 41% intravenous thrombolysis (IVT) alone, and 59% endovascular treatment (EVT). Twenty-two percent of those with mild deficits (National Institutes of Health Stroke Scale <4) and 50% of those 80 years of age or more received recanalization therapy. Compared with no treatment, recanalization therapy was not significantly associated with a favorable outcome (3-month modified Rankin scale, 0-2) (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI],.80-3.91; P =.16). However, compared with IVT, EVT significantly improved the odds of favorable outcome (OR, 2.86; 95% CI, 1.19-6.88; P =.02) without significant increase of symptomatic intracranial hemorrhage (OR, 2.18; 95% CI,.42-11.43; P =.36) and 3-month mortality (OR,.53; 95% CI,.23-1.18; P =.12). Successful recanalization rate (Thrombolysis in Cerebral Infarction <2a) by EVT was 76%.Conclusions In Korea, one tenth of acute ischemic stroke was caused by ICAO, and about 50% were treated by recanalization therapy. EVT was widely used as a recanalization modality (about 60% of cases) despite lack of evidence. However, its effectiveness and safety were acceptable.",

keywords = "Endovascular recanalization, acute stroke, carotid artery, revascularization, thrombolysis",

author = "Hong, {Jeong Ho} and Jihoon Kang and Jang, {Min Uk} and Kim, {Beom Joon} and Han, {Moon Ku} and Park, {Tai Hwan} and Park, {Sang Soon} and Lee, {Kyung Bok} and Lee, {Byung Chul} and Yu, {Kyung Ho} and Oh, {Mi Sun} and Cha, {Jae Kwan} and Kim, {Dae Hyun} and Jun Lee and Lee, {Soo Joo} and Youngchai Ko and Park, {Jong Moo} and Kyusik Kang and Cho, {Yong Jin} and Hong, {Keun Sik} and Cho, {Ki Hyun} and Kim, {Joon Tae} and Juneyoung Lee and Lee, {Ji Sung} and Bae, {Hee Joon}",

note = "Funding Information: This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry of Health and Welfare, Republic of Korea . ( HI10C2020 ). Publisher Copyright: {\textcopyright} 2014 National Stroke Association.",

year = "2014",

month = sep,

day = "1",

doi = "10.1016/j.jstrokecerebrovasdis.2014.04.025",

language = "English",

volume = "23",

pages = "2183--2189",

journal = "Journal of Stroke and Cerebrovascular Diseases",

issn = "1052-3057",

publisher = "W.B. Saunders Ltd",

number = "8",

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TY - JOUR

T1 - Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke

AU - Hong, Jeong Ho

AU - Kang, Jihoon

AU - Jang, Min Uk

AU - Kim, Beom Joon

AU - Han, Moon Ku

AU - Park, Tai Hwan

AU - Park, Sang Soon

AU - Lee, Kyung Bok

AU - Lee, Byung Chul

AU - Yu, Kyung Ho

AU - Oh, Mi Sun

AU - Cha, Jae Kwan

AU - Kim, Dae Hyun

AU - Lee, Jun

AU - Lee, Soo Joo

AU - Ko, Youngchai

AU - Park, Jong Moo

AU - Kang, Kyusik

AU - Cho, Yong Jin

AU - Hong, Keun Sik

AU - Cho, Ki Hyun

AU - Kim, Joon Tae

AU - Lee, Juneyoung

AU - Lee, Ji Sung

AU - Bae, Hee Joon

N1 - Funding Information: This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry of Health and Welfare, Republic of Korea . ( HI10C2020 ). Publisher Copyright: © 2014 National Stroke Association.

PY - 2014/9/1

Y1 - 2014/9/1

N2 - Background We aimed to describe the current status and clinical outcomes of recanalization therapy for internal carotid artery occlusion (ICAO) presenting as acute ischemic stroke.Methods Using a nationwide stroke registry database in Korea, we identified consecutive ischemic stroke patients with ICAO hospitalized within 12 hours of onset between March 2010 and November 2011.Results ICAO accounted for 10.6% (322 of 3028) of acute ischemic strokes within 12 hours of onset. Among the 322 ICAO patients, 53% underwent recanalization therapy, 41% intravenous thrombolysis (IVT) alone, and 59% endovascular treatment (EVT). Twenty-two percent of those with mild deficits (National Institutes of Health Stroke Scale <4) and 50% of those 80 years of age or more received recanalization therapy. Compared with no treatment, recanalization therapy was not significantly associated with a favorable outcome (3-month modified Rankin scale, 0-2) (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI],.80-3.91; P =.16). However, compared with IVT, EVT significantly improved the odds of favorable outcome (OR, 2.86; 95% CI, 1.19-6.88; P =.02) without significant increase of symptomatic intracranial hemorrhage (OR, 2.18; 95% CI,.42-11.43; P =.36) and 3-month mortality (OR,.53; 95% CI,.23-1.18; P =.12). Successful recanalization rate (Thrombolysis in Cerebral Infarction <2a) by EVT was 76%.Conclusions In Korea, one tenth of acute ischemic stroke was caused by ICAO, and about 50% were treated by recanalization therapy. EVT was widely used as a recanalization modality (about 60% of cases) despite lack of evidence. However, its effectiveness and safety were acceptable.

AB - Background We aimed to describe the current status and clinical outcomes of recanalization therapy for internal carotid artery occlusion (ICAO) presenting as acute ischemic stroke.Methods Using a nationwide stroke registry database in Korea, we identified consecutive ischemic stroke patients with ICAO hospitalized within 12 hours of onset between March 2010 and November 2011.Results ICAO accounted for 10.6% (322 of 3028) of acute ischemic strokes within 12 hours of onset. Among the 322 ICAO patients, 53% underwent recanalization therapy, 41% intravenous thrombolysis (IVT) alone, and 59% endovascular treatment (EVT). Twenty-two percent of those with mild deficits (National Institutes of Health Stroke Scale <4) and 50% of those 80 years of age or more received recanalization therapy. Compared with no treatment, recanalization therapy was not significantly associated with a favorable outcome (3-month modified Rankin scale, 0-2) (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI],.80-3.91; P =.16). However, compared with IVT, EVT significantly improved the odds of favorable outcome (OR, 2.86; 95% CI, 1.19-6.88; P =.02) without significant increase of symptomatic intracranial hemorrhage (OR, 2.18; 95% CI,.42-11.43; P =.36) and 3-month mortality (OR,.53; 95% CI,.23-1.18; P =.12). Successful recanalization rate (Thrombolysis in Cerebral Infarction <2a) by EVT was 76%.Conclusions In Korea, one tenth of acute ischemic stroke was caused by ICAO, and about 50% were treated by recanalization therapy. EVT was widely used as a recanalization modality (about 60% of cases) despite lack of evidence. However, its effectiveness and safety were acceptable.

KW - Endovascular recanalization

KW - acute stroke

KW - carotid artery

KW - revascularization

KW - thrombolysis

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U2 - 10.1016/j.jstrokecerebrovasdis.2014.04.025

DO - 10.1016/j.jstrokecerebrovasdis.2014.04.025

M3 - Article

C2 - 25018113

AN - SCOPUS:84908127244

SN - 1052-3057

VL - 23

SP - 2183

EP - 2189

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

IS - 8

ER -

Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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