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This article is available at e-publications@RCSI: http://epubs.rcsi.ie/gerstrmedart/1 -Use LicenceThis work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.This article is available at e-publications@RCSI: http://epubs.rcsi.ie/gerstrmedart/1T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med nejm.org

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Multiphase CT angiography is a reliable tool for imaging selection in patients with AIS.

Background and Purpose-Acute rates of recanalization after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) in proximal vessel occlusion have been estimated sparingly, typically using transcranial Doppler (TCD). We aimed to study acute recanalization rates of IV rt-PA in CT angiogram-proven proximal (internal carotid artery [ICA], M1 middle cerebral artery [MCA], M2-MCA, and basilar artery) occlusions and their effects on outcome. Materials and Methods-The CT angiogram database of the Calgary stroke program was reviewed for the period 2002 to 2009. All patients with proximal vessel occlusions receiving IV rt-PA who were assessed for recanalization by TCD or angiogram (for acute endovascular treatment) were included for analysis. Rates of acute recanalization as observed on TCD/first run of angiogram and postendovascular therapy recanalization rates were noted. Modified Rankin Scale score Յ2 at 3 months was used as a good outcome. Results-Among 1341 patients in the CT angiogram database, 388 patients with proximal occlusion were identified. Of these, 216 patients had received IV rt-PA; 127 patients underwent further imaging to assess recanalization. Among the patients undergoing TCD (nϭ46) and cerebral angiogram (nϭ103), only 27 (21.25%) patients had acute recanalization. By occlusion subtype, the rates of recanalization were: distal ICA (with or without ICA neck occlusion or stenotic disease) 1 of 24 (4.4%); M1-MCA (with or without ICA neck occlusion or stenotic disease) 21 of 65 (32.3%); M2-MCA 4 of 13 (30.8%); and basilar artery 1 of 25 (4%). Onset to rt-PA time was comparable in patients with and without recanalization. Recanalization (PϽ0.0001; risk ratio, 2.7; 95% confidence interval, 1.5-4.6) was the strongest predictor of outcome (adjusted for age and National Institutes of Health Stroke Scale score). Key Words: intracranial occlusion Ⅲ ischemic stroke Ⅲ recanalization Ⅲ thrombolysis I ntravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment for acute ischemic stroke 1,2 works by achieving recanalization of intracranial occlusion resulting in restoration of flow and prevention of infarct expansion. 3 Data on recanalization after IV thrombolysis are limited to small angiographic and transcranial Doppler (TCD) monitoring studies. 4 None of the major IV thrombolysis trials has assessed the baseline occlusion status or recanalization rates after treatment. In an era when there is increasing use of endovascular therapies for recanalization, in the absence of robust evidence from randomized controlled trials, there is a desperate need for clear data on the rates of recanalization with IV rt-PA. 5 The present study reports the rates of acute recanalization of proximal intracranial vessel occlusions identified by baseline CT angiography (CTA) among acute ischemic stroke patients treated with IV rt-PA. Conclusions- Patients and MethodsWe identified patients presenting with acute ischemic stroke secondary to major vessel occlusion from the CT Angiography database of the Calgary St...

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BACKGROUND AND PURPOSE:Carotid webs may cause recurrent ischemic stroke. We describe the prevalence, demographics, clinical presentation, imaging features, histopathology, and stroke risk associated with this under-recognized lesion.

Medtronic.