BMC neurology, 2019. 19(1), 11-, DOI: https://doi.org/10.1186/s12883-019-1237-2

Futile Reperfusion and Predicted Therapeutic Benefits after Successful Endovascular Treatment According to Initial Stroke Severity

Sang-Hwa Lee, Beom Joon Kim;Moon-Ku Han;Tai Hwan Park;Kyung Bok Lee;Byung-Chul Lee;Kyung-Ho Yu;Mi Sun Oh;Jae Kwan Cha;Dae-Hyun Kim;Hyun-Wook Nah;Jun Lee;Soo Joo Lee;Jae Guk Kim;Jong-Moo Park;Kyusik Kang;Yong-Jin Cho;Keun-Sik Hong;Hong-Kyun Park;Jay Chol Choi;Joon-Tae Kim;Kangho Choi;Dong-Eog Kim;Wi-Sun Ryu;Wook-Joo Kim;Dong-Ick Shin;Minju Yeo;Sung-Il Sohn;Jeong-Ho Hong;Juneyoung Lee;Ji Sung Lee;Pooja Khatri;Hee-Joon Bae

Abstract

Background: Futile reperfusion (poor functional status despite successful reperfusion) was observed in up to 67% of patients enrolled in recent endovascular treatment (EVT) clinical trials. We investigated the impact of baseline stroke severity on both futile reperfusion and therapeutic benefit of successful EVT.

Methods: Using a prospective multicenter stroke registry, we identified consecutive ischemic stroke patients with anterior circulation large artery occlusion, who were reperfused successfully by EVT (Thrombolysis in Cerebral Infarction grade 2b–3). The rate of futile reperfusion was assessed across the initial National Institutes of Health Stroke Scale (NIHSS) scores. The frequency of poor outcomes (modified Rankin scale [mRS] 3–6) according to NIHSS scores was compared between patients revascularized successfully by EVT and those who did not receive EVT, after standardizing for age.

Results: Among 21,591 patients with ischemic stroke, 972 (4.5%) received EVT within 12 h of onset, including 440 who met study eligibility criteria. Futile reperfusion was observed in 226 of the 440 study-eligible patients (51.4%) and was associated with stroke severity: 20.9% in NIHSS scores ≤5, 34.6% in 6–10, 58.9% in 11–20, and 63.8% in > 20 (p < 0.001). Nonetheless, the therapeutic benefit of EVT also increased with increasing stroke severity (p for interaction < 0.001): 0.1% in NIHSS ≤5, 18.6% in 6–10, 28.7% in 11–20, and 34.3% in > 20.

Conclusions: EVT is more beneficial with increasing stroke severity, although futile reperfusion also increases with higher stroke severity.

• DOI: https://doi.org/10.1186/s12883-019-1237-2
• ISBN or ISSN: 1471-2377

• 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
• This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.