Current status of recanalization therapy in acute ischemic stroke with symptomatic intracranial arterial occlusion in Korea

Abstract

Background: Recent methodological advances in recanalization therapy may alter recanalization strategies and clinical outcomes in patients with symptomatic occlusion of intracranial cerebral arteries. However, few studies have analyzed these changes at a national level, with none conducted in Korea.

Methods: On the basis of a prospective multicenter stroke registry database in Korea, 642 consecutive patients hospitalized within 12 hours of the onset with symptomatic occlusion of intracranial major cerebral arteries between March 2010 and November 2011 were identified. Recanalization therapy was used in 48% (n = 307) of patients; intravenous thrombolysis only (IVT) in 46%, intra-arterial thrombolysis only (IAT) in 16%, and combined thrombolysis (CMT) in 38%. Of the 166 patients treated by IAT or CMT, the Penumbra system or the Solitaire was used in 58% of patients.

Results: Early neurologic improvement (ENI), 3-month modified Rankin scale (mRS) score of 2 or less, and symptomatic hemorrhagic transformation (SHT) were observed in 43%, 39%, and 9% of the patients in the IVT group; 52%, 27%, and 12% of the patients in the IAT group; and 54%, 39%, and 12% of the patients in the CMT group, respectively. Compared with no treatment, adjusted odd ratios (95% confidence intervals) of recanalization therapy were 1.59 (1.04-2.42) for ENI, 1.37 (.81-2.30) for 3-month mRS score of 2 or less, and 2.58 (1.12-5.91) for SHT.

Conclusions: The variety and active use of endovascular approaches were quite noticeable. As a whole, recanalization therapy tended to contribute to favorable outcomes despite a significant increase of symptomatic hemorrhage.

Keywords: Korea; Recanalization therapy; acute ischemic stroke; endovascular treatment; intracranial arterial occlusion; outcome; registry; thrombolysis.