Who fucking cares about recanalization? The goal is 100% recovery, NOT these intermediate steps. Measure the correct item; Full recovery, NOTHING LESS!
Incidence, Predictors, and Prediction Scores
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Originally published25 Oct 2018Stroke. 2018;0:STROKEAHA.118.022335
Abstract
Background and Purpose—
Whether
all acute stroke patients with large vessel occlusion need to undergo
intravenous thrombolysis before mechanical thrombectomy (MT) is debated
as (1) the incidence of post-thrombolysis early recanalization (ER) is
still unclear; (2) thrombolysis may be harmful in patients unlikely to
recanalize; and, conversely, (3) transfer for MT may be unnecessary in
patients highly likely to recanalize. Here, we determined the incidence
and predictors of post-thrombolysis ER in patients referred for MT and
derive ER prediction scores for trial design.
Methods—
Registries
from 4 MT-capable centers gathering patients referred for MT and
thrombolyzed either on site (mothership) or in a non MT-capable center
(drip-and-ship) after magnetic resonance– or computed tomography–based
imaging between 2015 and 2017. ER was identified on either first
angiographic run or noninvasive imaging. In the magnetic resonance
imaging subsample, thrombus length was determined on T2*-based
susceptibility vessel sign. Independent predictors of no-ER were
identified using multivariable logistic regression models, and scores
were developed according to the magnitude of regression coefficients.
Similar registries from 4 additional MT-capable centers were used as
validation cohort.
Results—
In
the derivation cohort (N=633), ER incidence was ≈20%. In patients with
susceptibility vessel sign (n=498), no-ER was independently predicted by
long thrombus, proximal occlusion, and mothership paradigm. A 6-point
score derived from these variables showed strong discriminative power
for no-ER (C statistic, 0.854) and was replicated in the validation
cohort (n=353; C statistic, 0.888). A second score derived from the
whole sample (including negative T2* or computed tomography–based
imaging) also showed good discriminative power and was similarly
validated. Highest grades on both scores predicted no-ER with >90%
specificity, whereas low grades did not reliably predict ER.
Conclusions—
The
substantial ER rate underlines the benefits derived from thrombolysis
in bridging populations. Both prediction scores afforded high
specificity for no-ER, but not for ER, which has implications for trial
design. (Yeah, design the trials so these measure the correct outcome, 100% recovery. Your mentors and senior researchers need to be horse whipped for such bad research.)
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