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Revascularization Results in the Interventional Management of Stroke II Trial

Revascularization Results in the Interventional Management of Stroke II Trial This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Tomsick, T. Search for Related Content PubMed PubMed Citation Articles by Tomsick, T. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 29:582-587, March 2008 © 2008 American Society of Neuroradiology INTERVENTIONAL Revascularization Results in the Interventional Management of Stroke II Trial T. Tomsick a , J. Broderick b , J. Carrozella a , P. Khatri b , M. Hill d , Y. Palesch e , J. Khoury c for the Interventional Management of Stroke II Investigators a Departments of Radiology, University of Cincinnati, Cincinnati, Ohio b Neurology, University of Cincinnati, Cincinnati, Ohio c Environmental Health, University of Cincinnati, Cincinnati, Ohio d Department of Clinical Neurosciences and Community Health Sciences, University of Calgary, Alberta, Canada e Department of Biostatistics, Bioformatics, and Epidemiology, University of South Carolina, Charleston, SC Please address correspondence to Thomas Tomsick, MD, Radiology Department, University of Cincinnati Hospital, 234 Goodman St, Cincinnati, OH 45267-0762; e-mail: tomsicta@healthall.com BACKGROUND AND PURPOSE: Our aim was to detail revascularization results, including impact on outcome and mortality, in the Interventional Management of Stroke (IMS) II trial. MATERIALS AND METHODS: IMS II was designed to obtain estimates of the efficacy and safety of reduced-dose intravenous recombinant tissue plasminogen activator (rtPA) followed by additional intra-arterial rtPA and low-energy sonography via the EKOS Primo Micro-Infusion Catheter at the occlusion in selected patients with ischemic stroke treated within 3 hours of onset. Revascularization outcomes were detailed and compared with modified Rankin Scale scores 0–2, mortality outcomes, and results from IMS I. RESULTS: Complete recanalization at 60 minutes occurred in 12 of 29 (41.4%) sonography microcatheter–treated occlusions. Complete recanalization was achieved at 2 hours or procedure end in 20/29 (68.9%) in the ultrasound catheter–treated group, and final thrombolysis in cerebral infarction (TICI) 2/3 reperfusion was achieved in 18/29 (62.0%) ultrasound-treated subjects. Fifteen-minute angiograms demonstrated some recanalization in 69/145 (46.7%) sonography microcatheter treatment intervals, compared with 39/111 (35.1%) in IMS I treatments in 23 subjects with reliable 15-minute angiograms ( P = .046). Pooled IMS I-II data demonstrated that partial or complete recanalization occurred in 56/75 (74.6%) and good reperfusion (TICI 2/3) occurred in 46/75 (61.3%) of internal carotid artery T and M1 occlusions. Revascularization correlated with good outcome for TICI 2/3 reperfusion ( P = .0004), TICI 2B/3 reperfusion ( P = .0002), and arterial occlusive lesion 2/3 recanalization ( P = .03). CONCLUSION: IMS II provides evidence that the EKOS Primo sonography microcatheter exhibits a trend toward improved recanalization of the occlusion compared with a standard microcatheter and again confirms the correlation between recanalization and reperfusion with good clinical outcome and reduced mortality. This article has been cited by other articles: P. M. Meyers, H. C. Schumacher, R. T. Higashida, S. L. Barnwell, M. A. Creager, R. Gupta, C. G. McDougall, D. K. Pandey, D. Sacks, and L. R. Wechsler Indications for the performance of intracranial endovascular neurointerventional procedures. A scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research JNIS, June 1, 2010; 2(2): 177 - 188. Full Text PDF Z. S. Shi, Y. Loh, G. Walker, G. R. Duckwiler, and for the MERCI and Multi MERCI Investigators Endovascular Thrombectomy for Acute Ischemic Stroke in Failed Intravenous Tissue Plasminogen Activator Versus Non-Intravenous Tissue Plasminogen Activator Patients: Revascularization and Outcomes Stratified by the Site of Arterial Occlusions Stroke, June 1, 2010; 41(6): 1185 - 1192. Abstract Full Text PDF Z. S. Shi, Y. Loh, G. Walker, G. R. Duckwiler, and for the MERCI and Multi-MERCI Investigators Clinical Outcomes in Middle Cerebral Artery Trunk Occlusions Versus Secondary Division Occlusions After Mechanical Thrombectomy: Pooled Analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials Stroke, May 1, 2010; 41(5): 953 - 960. Abstract Full Text PDF T. A. Tomsick, P. Khatri, T. Jovin, B. Demaerschalk, T. Malisch, A. Demchuk, M. D. Hill, E. Jauch, J. Spilker, J. P. Broderick, et al. Equipoise among recanalization strategies Neurology, March 30, 2010; 74(13): 1069 - 1076. Abstract Full Text PDF H.M. Hussein, A.L. Georgiadis, G. Vazquez, J.T. Miley, M.Z. Memon, Y.M. Mohammad, G.A. Christoforidis, N. Tariq, and A.I. Qureshi Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study AJNR Am. J. Neuroradiol., March 1, 2010; 31(3): 454 - 458. Abstract Full Text PDF B. P. Soares, E. Tong, J. Hom, S.-C. Cheng, J. Bredno, L. Boussel, W. S. Smith, and M. Wintermark Reperfusion Is a More Accurate Predictor of Follow-Up Infarct Volume Than Recanalization: A Proof of Concept Using CT in Acute Ischemic Stroke Patients Stroke, January 1, 2010; 41(1): e34 - e40. Abstract Full Text PDF R. G. Nogueira, D. S. Liebeskind, G. Sung, G. Duckwiler, W. S. Smith, and on Behalf of the MERCI; and Multi MERCI Writing Co Predictors of Good Clinical Outcomes, Mortality, and Successful Revascularization in Patients With Acute Ischemic Stroke Undergoing Thrombectomy: Pooled Analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials Stroke, December 1, 2009; 40(12): 3777 - 3783. Abstract Full Text PDF A. J. Yoo, L. A. Verduzco, P. W. Schaefer, J. A. Hirsch, J. D. Rabinov, and R. G. Gonzalez MRI-Based Selection for Intra-Arterial Stroke Therapy: Value of Pretreatment Diffusion-Weighted Imaging Lesion Volume in Selecting Patients With Acute Stroke Who Will Benefit From Early Recanalization Stroke, June 1, 2009; 40(6): 2046 - 2054. Abstract Full Text PDF R.G. Nogueira, A.J. Yoo, F.S. Buonanno, and J.A. Hirsch Endovascular Approaches to Acute Stroke, Part 2: A Comprehensive Review of Studies and Trials AJNR Am. J. Neuroradiol., May 1, 2009; 30(5): 859 - 875. Abstract Full Text PDF A. K. Wakhloo, M. J. Deleo III, and M. M. Brown Advances in Interventional Neuroradiology Stroke, May 1, 2009; 40(5): e305 - e312. Abstract Full Text PDF P. M. Meyers, H. C. Schumacher, R. T. Higashida, S. L. Barnwell, M. A. Creager, R. Gupta, C. G. McDougall, D. K. Pandey, D. Sacks, and L. R. Wechsler Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research Circulation, April 28, 2009; 119(16): 2235 - 2249. Full Text PDF B. P. Soares, J. D. Chien, and M. Wintermark MR and CT Monitoring of Recanalization, Reperfusion, and Penumbra Salvage: Everything That Recanalizes Does Not Necessarily Reperfuse! Stroke, March 1, 2009; 40(3_suppl_1): S24 - S27. Abstract Full Text PDF A. V. Alexandrov Ultrasound Enhancement of Fibrinolysis Stroke, March 1, 2009; 40(3_suppl_1): S107 - S110. Abstract Full Text PDF Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Revascularization Results in the Interventional Management of Stroke II Trial

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A0843
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See Article on Publisher Site

Abstract

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Tomsick, T. Search for Related Content PubMed PubMed Citation Articles by Tomsick, T. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 29:582-587, March 2008 © 2008 American Society of Neuroradiology INTERVENTIONAL Revascularization Results in the Interventional Management of Stroke II Trial T. Tomsick a , J. Broderick b , J. Carrozella a , P. Khatri b , M. Hill d , Y. Palesch e , J. Khoury c for the Interventional Management of Stroke II Investigators a Departments of Radiology, University of Cincinnati, Cincinnati, Ohio b Neurology, University of Cincinnati, Cincinnati, Ohio c Environmental Health, University of Cincinnati, Cincinnati, Ohio d Department of Clinical Neurosciences and Community Health Sciences, University of Calgary, Alberta, Canada e Department of Biostatistics, Bioformatics, and Epidemiology, University of South Carolina, Charleston, SC Please address correspondence to Thomas Tomsick, MD, Radiology Department, University of Cincinnati Hospital, 234 Goodman St, Cincinnati, OH 45267-0762; e-mail: tomsicta@healthall.com BACKGROUND AND PURPOSE: Our aim was to detail revascularization results, including impact on outcome and mortality, in the Interventional Management of Stroke (IMS) II trial. MATERIALS AND METHODS: IMS II was designed to obtain estimates of the efficacy and safety of reduced-dose intravenous recombinant tissue plasminogen activator (rtPA) followed by additional intra-arterial rtPA and low-energy sonography via the EKOS Primo Micro-Infusion Catheter at the occlusion in selected patients with ischemic stroke treated within 3 hours of onset. Revascularization outcomes were detailed and compared with modified Rankin Scale scores 0–2, mortality outcomes, and results from IMS I. RESULTS: Complete recanalization at 60 minutes occurred in 12 of 29 (41.4%) sonography microcatheter–treated occlusions. Complete recanalization was achieved at 2 hours or procedure end in 20/29 (68.9%) in the ultrasound catheter–treated group, and final thrombolysis in cerebral infarction (TICI) 2/3 reperfusion was achieved in 18/29 (62.0%) ultrasound-treated subjects. Fifteen-minute angiograms demonstrated some recanalization in 69/145 (46.7%) sonography microcatheter treatment intervals, compared with 39/111 (35.1%) in IMS I treatments in 23 subjects with reliable 15-minute angiograms ( P = .046). Pooled IMS I-II data demonstrated that partial or complete recanalization occurred in 56/75 (74.6%) and good reperfusion (TICI 2/3) occurred in 46/75 (61.3%) of internal carotid artery T and M1 occlusions. Revascularization correlated with good outcome for TICI 2/3 reperfusion ( P = .0004), TICI 2B/3 reperfusion ( P = .0002), and arterial occlusive lesion 2/3 recanalization ( P = .03). CONCLUSION: IMS II provides evidence that the EKOS Primo sonography microcatheter exhibits a trend toward improved recanalization of the occlusion compared with a standard microcatheter and again confirms the correlation between recanalization and reperfusion with good clinical outcome and reduced mortality. This article has been cited by other articles: P. M. Meyers, H. C. Schumacher, R. T. Higashida, S. L. Barnwell, M. A. Creager, R. Gupta, C. G. McDougall, D. K. Pandey, D. Sacks, and L. R. Wechsler Indications for the performance of intracranial endovascular neurointerventional procedures. A scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research JNIS, June 1, 2010; 2(2): 177 - 188. Full Text PDF Z. S. Shi, Y. Loh, G. Walker, G. R. Duckwiler, and for the MERCI and Multi MERCI Investigators Endovascular Thrombectomy for Acute Ischemic Stroke in Failed Intravenous Tissue Plasminogen Activator Versus Non-Intravenous Tissue Plasminogen Activator Patients: Revascularization and Outcomes Stratified by the Site of Arterial Occlusions Stroke, June 1, 2010; 41(6): 1185 - 1192. Abstract Full Text PDF Z. S. Shi, Y. Loh, G. Walker, G. R. Duckwiler, and for the MERCI and Multi-MERCI Investigators Clinical Outcomes in Middle Cerebral Artery Trunk Occlusions Versus Secondary Division Occlusions After Mechanical Thrombectomy: Pooled Analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials Stroke, May 1, 2010; 41(5): 953 - 960. Abstract Full Text PDF T. A. Tomsick, P. Khatri, T. Jovin, B. Demaerschalk, T. Malisch, A. Demchuk, M. D. Hill, E. Jauch, J. Spilker, J. P. Broderick, et al. Equipoise among recanalization strategies Neurology, March 30, 2010; 74(13): 1069 - 1076. Abstract Full Text PDF H.M. Hussein, A.L. Georgiadis, G. Vazquez, J.T. Miley, M.Z. Memon, Y.M. Mohammad, G.A. Christoforidis, N. Tariq, and A.I. Qureshi Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study AJNR Am. J. Neuroradiol., March 1, 2010; 31(3): 454 - 458. Abstract Full Text PDF B. P. Soares, E. Tong, J. Hom, S.-C. Cheng, J. Bredno, L. Boussel, W. S. Smith, and M. Wintermark Reperfusion Is a More Accurate Predictor of Follow-Up Infarct Volume Than Recanalization: A Proof of Concept Using CT in Acute Ischemic Stroke Patients Stroke, January 1, 2010; 41(1): e34 - e40. Abstract Full Text PDF R. G. Nogueira, D. S. Liebeskind, G. Sung, G. Duckwiler, W. S. Smith, and on Behalf of the MERCI; and Multi MERCI Writing Co Predictors of Good Clinical Outcomes, Mortality, and Successful Revascularization in Patients With Acute Ischemic Stroke Undergoing Thrombectomy: Pooled Analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials Stroke, December 1, 2009; 40(12): 3777 - 3783. Abstract Full Text PDF A. J. Yoo, L. A. Verduzco, P. W. Schaefer, J. A. Hirsch, J. D. Rabinov, and R. G. Gonzalez MRI-Based Selection for Intra-Arterial Stroke Therapy: Value of Pretreatment Diffusion-Weighted Imaging Lesion Volume in Selecting Patients With Acute Stroke Who Will Benefit From Early Recanalization Stroke, June 1, 2009; 40(6): 2046 - 2054. Abstract Full Text PDF R.G. Nogueira, A.J. Yoo, F.S. Buonanno, and J.A. Hirsch Endovascular Approaches to Acute Stroke, Part 2: A Comprehensive Review of Studies and Trials AJNR Am. J. Neuroradiol., May 1, 2009; 30(5): 859 - 875. Abstract Full Text PDF A. K. Wakhloo, M. J. Deleo III, and M. M. Brown Advances in Interventional Neuroradiology Stroke, May 1, 2009; 40(5): e305 - e312. Abstract Full Text PDF P. M. Meyers, H. C. Schumacher, R. T. Higashida, S. L. Barnwell, M. A. Creager, R. Gupta, C. G. McDougall, D. K. Pandey, D. Sacks, and L. R. Wechsler Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research Circulation, April 28, 2009; 119(16): 2235 - 2249. Full Text PDF B. P. Soares, J. D. Chien, and M. Wintermark MR and CT Monitoring of Recanalization, Reperfusion, and Penumbra Salvage: Everything That Recanalizes Does Not Necessarily Reperfuse! Stroke, March 1, 2009; 40(3_suppl_1): S24 - S27. Abstract Full Text PDF A. V. Alexandrov Ultrasound Enhancement of Fibrinolysis Stroke, March 1, 2009; 40(3_suppl_1): S107 - S110. Abstract Full Text PDF Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of Neuroradiology – American Journal of Neuroradiology

Published: Mar 1, 2008

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