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Ischemic stroke
ORIGINAL RESEARCH
Lesion location, stability, and pretreatment management: factors affecting outcomes of endovascular treatment for vertebrobasilar atherosclerosis Matthew D Alexander,1 Jeffrey M Rebhun,2 Steven W Hetts,3 Anthony S Kim,4 Jeffrey Nelson,5 Helen Kim,5 Matthew R Amans,3 Fabio Settecase,3 Christopher F Dowd,3 Van V Halbach,3 Randall T Higashida,3 Daniel L Cooke3 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ neurintsurg-2014-011633). 1
Department of Radiology, University of Washington, Seattle, Washington, USA 2 University of California, Berkeley, California, USA 3 Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA 4 Department of Neurology, University of California San Francisco, San Francisco, California, USA 5 Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA Correspondence to Dr D L Cooke, Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 941430628, USA; [email protected] Received 30 December 2014 Revised 24 February 2015 Accepted 2 March 2015
To cite: Alexander MD, Rebhun JM, Hetts SW, et al. J NeuroIntervent Surg Published Online First: [please include Day Month Year] doi:10.1136/ neurintsurg-2014-011633
ABSTRACT Background and purpose The proper role of endovascular treatment of cervicocerebral atherosclerosis is unclear. Posterior circulation disease has not been investigated as extensively as disease in the anterior circulation. In this study, we characterized the rates of technical success, transient ischemic attack, stroke, and death or disability, for both acute and elective endovascular treatment of atherosclerosis in the vertebrobasilar system. Methods We identified patients with atherosclerosis of the vertebrobasilar circulation who underwent endovascular intervention at our hospital through retrospective medical record review, and evaluated the association between lesion and treatment features and subsequent stroke, death, or disability at 30 days and 1 year. Results We identified 136 lesions in 122 patients, including 13 interventions for acute strokes. Technical success was achieved in 123 of 136 cases (90.4%). Elective procedures had higher rates of technical success (6.5% vs 15.4%, p=0.21) and better clinical outcomes. In multivariate analysis, intracranial lesions were associated with more disability (modified Rankin Scale score >2) at 30 days (OR 7.1, p=0.01) and 1 year (OR 10, p=0.03). Patients with non-hypoperfusion related symptoms had fewer strokes at follow-up at 1 year when treated after an asymptomatic interval of >10 days compared with those treated within 10 days of the presenting symptoms (OR 0.2, p=0.03). Statin treatment prior to intervention was associated with favorable outcomes across several examined endpoints. Preoperative antiplatelet treatment was associated with lower rates of disability at 30 days and 1 year (OR 0.1, p
Ischemic stroke
ORIGINAL RESEARCH
Lesion location, stability, and pretreatment management: factors affecting outcomes of endovascular treatment for vertebrobasilar atherosclerosis Matthew D Alexander,1 Jeffrey M Rebhun,2 Steven W Hetts,3 Anthony S Kim,4 Jeffrey Nelson,5 Helen Kim,5 Matthew R Amans,3 Fabio Settecase,3 Christopher F Dowd,3 Van V Halbach,3 Randall T Higashida,3 Daniel L Cooke3 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ neurintsurg-2014-011633). 1
Department of Radiology, University of Washington, Seattle, Washington, USA 2 University of California, Berkeley, California, USA 3 Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA 4 Department of Neurology, University of California San Francisco, San Francisco, California, USA 5 Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA Correspondence to Dr D L Cooke, Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 941430628, USA; [email protected] Received 30 December 2014 Revised 24 February 2015 Accepted 2 March 2015
To cite: Alexander MD, Rebhun JM, Hetts SW, et al. J NeuroIntervent Surg Published Online First: [please include Day Month Year] doi:10.1136/ neurintsurg-2014-011633
ABSTRACT Background and purpose The proper role of endovascular treatment of cervicocerebral atherosclerosis is unclear. Posterior circulation disease has not been investigated as extensively as disease in the anterior circulation. In this study, we characterized the rates of technical success, transient ischemic attack, stroke, and death or disability, for both acute and elective endovascular treatment of atherosclerosis in the vertebrobasilar system. Methods We identified patients with atherosclerosis of the vertebrobasilar circulation who underwent endovascular intervention at our hospital through retrospective medical record review, and evaluated the association between lesion and treatment features and subsequent stroke, death, or disability at 30 days and 1 year. Results We identified 136 lesions in 122 patients, including 13 interventions for acute strokes. Technical success was achieved in 123 of 136 cases (90.4%). Elective procedures had higher rates of technical success (6.5% vs 15.4%, p=0.21) and better clinical outcomes. In multivariate analysis, intracranial lesions were associated with more disability (modified Rankin Scale score >2) at 30 days (OR 7.1, p=0.01) and 1 year (OR 10, p=0.03). Patients with non-hypoperfusion related symptoms had fewer strokes at follow-up at 1 year when treated after an asymptomatic interval of >10 days compared with those treated within 10 days of the presenting symptoms (OR 0.2, p=0.03). Statin treatment prior to intervention was associated with favorable outcomes across several examined endpoints. Preoperative antiplatelet treatment was associated with lower rates of disability at 30 days and 1 year (OR 0.1, p
