Factors Influencing Clinically Meaningful Recanalization after IV-rtPA in Acute Ischemic Stroke

Abstract

BACKGROUND AND PURPOSE:Recanalization may not result in better clinical outcomes after ischemic stroke. We determined the incidence and significant predictors of CMR, defined as CT angiographic recanalization and a good clinical outcome, after IV-rtPA in acute ischemic stroke. A CMR score was devised and tested.

Effect of Collaterals on Clinical Presentation, Baseline Imaging, Complications, and Outcome in Acute Stroke

“…Most important, the proportion of patients of mRS Ͼ2 in patients who were RϪ with good collaterals was similar to that of patients who were collateral-negative and Rϩ, reinforcing the importance of both recanalization and collaterals in avoiding futile recanalization. 21,22 The findings underscore the utility of collateral assessment in predicting outcome irrespective of final recanalization status, consistent with findings of others. 2,4 Preserved collaterals irrespective of recanalization status were associated with reduced baseline ischemic tissue (including baseline infarct core) and smaller final infarct volume, contributing to a better outcome (Fig 1).…”

Predictors of Reperfusion in Patients with Acute Ischemic Stroke

“…A positive relation between distal thrombus location and recanalization has been found in multiple studies. 7,[31][32][33] In contrast, Lemmens et al 34 found no relation between distal occlusion and recanalization, though they did find a better clinical response with increased reperfusion. Moreover, none of our patients with an intracranial carotid occlusion showed complete reperfusion (despite complete recanalization in 15% and 54% receiving IV-rtPA in this patient group of 13 patients).…”

“…7,16,24,32,[39][40][41][42][43][44][45] In addition, several articles describing predictors of reperfusion or recanalization showed a good correlation between these predic- Follow-up CTA shows complete recanalization; no distal M3 occlusion could be found. Admission CTP shows a large area of decreased MTT and CBV in ASPECTS M5 and M6.…”

“…5,6 Many previous studies, including those investigating intra-arterial therapy, consider recanalization to be synonymous with reperfusion. [7][8][9][10] Other articles suggest that this assumption is not justified and found reperfusion to be a better predictor of follow-up infarct volume and clinical outcome than recanalization. 5,8,9,[11][12][13][14][15] Although recanalization correlates well with improved reperfusion rates, it is unclear which other clinical and imaging factors influence reperfusion.…”

Contribution and Additional Impact of Imaging to the SPAN-100 Score

“…23 The addition of CBV and clot burden score, however, increased predictions to 74%. A systematic review by Schiemanck et al 24 and several other studies 7,10,25 corroborated the importance of lesion volume and neurologic deficit assessed by the NIHSS score for clinical-outcome determination. Clot location and volume were both previously shown to be important independent prognostic factors of outcome.…”