Early recanalization in large-vessel occlusion stroke patients transferred for endovascular treatment

Abstract

BackgroundWe performed an exploratory analysis to identify patient and thrombus characteristics associated with early recanalization in large-vessel occlusion (LVO) stroke patients transferred for endovascular treatment (EVT) from a primary (PSC) to a comprehensive stroke center (CSC).MethodsWe included patients with an LVO stroke of the anterior circulation who were transferred to our hospital for EVT and underwent repeated imaging between January 2016 and June 2019. We compared patient characteristics, workflow time metrics, functional outcome (modified Rankin Scale at 90 days), and baseline thrombus imaging characteristics, which included: occlusion location, thrombus length, attenuation, perviousness, distance from terminus of intracranial carotid artery to the thrombus (DT), and clot burden score (CBS), between early-recanalized LVO (ER-LVO), and non-early-recanalized LVO (NER-LVO) patients.ResultsOne hundred and forty-nine patients were included in the analysis. Early recanalization occurred in 32% of patients. ER-LVO patients less often had a medical history of hypertension (31% vs 49%, P=0.04), and more often had clinical improvement between PSC and CSC (ΔNIHSS −5 vs 3, P<0.01), compared with NER-LVO patients. Thrombolysis administration was similar in both groups (88% vs 78%, P=0.18). ER-LVO patients had no ICA occlusions (0% vs 27%, P<0.01), more often an M2 occlusion (35% vs 17%, P=0.01), longer DT (27 mm vs 12 mm, P<0.01), shorter thrombi (17 mm vs 27 mm, P<0.01), and higher CBS (8 vs 6, P<0.01) at baseline imaging. ER-LVO patients had lower mRS scores (1 vs 3, P=0.02).ConclusionsEarly recanalization is associated with clinical improvement between PSC and CSC admission, more distal occlusions and shorter thrombi at baseline imaging, and better functional outcome.

Tenecteplase Improves Reperfusion across Time in Large Vessel Stroke

“…Achieving early reperfusion in an acute ischemic stroke strongly influences clinical outcomes 1–4 . In large vessel occlusion (LVO) patients treated with intravenous alteplase, the reported rates of thrombolytic agent‐induced reperfusion prior to endovascular therapy ranges from 10 to 30% 5–8 .…”

Predictive value of clot imaging in acute ischemic stroke: A systematic review of artificial intelligence and conventional studies

“…Lower thrombus extent was found to be critical for the effectiveness of IV-tPA [57] and associated with early recanalization following IV-tPA treatment [81], and thrombus length was found a powerful independent predictor of no-early recanalization following IV-tPA treatment in minor strokes [82]. Short SVS was found to be a predictor of excellent outcome at 3 months in patients with stroke with LVO treated with IV-tPA alone [71].…”

“…It was found that the occlusion location is a predictor for RBC content [38], and it is associated with postprocedural hemorrhage [54]. Early recanalization following IV-tPA treatment was associated with more distal occlusion [81]. As compared with patients with severe stroke, patients with mild stroke had more distal occlusions [62].…”

Influence of prior intravenous thrombolysis in patients treated with mechanical thrombectomy for M2 occlusions: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) registry

“…Indeed, IVT may facilitate cerebral reperfusion and arterial recanalization. It has been well identified that M2 occlusions have higher chances of early recanalization after IVT than intracranial internal carotid artery or M1 occlusions 14 15. However, MT in M2 occlusion can also be more challenging, involving more distal arteries potentially increasing operative risk 16–18.…”