American Journal of Neuroradiology 26:880-884, April 2005
© 2005 American Society of Neuroradiology
INTERVENTIONAL
Thrombolytic Therapy of Acute Ischemic Stroke: Correlation of Angiographic Recanalization with Clinical Outcome
a Department of Neurology, Case Western University Medical Center, Cleveland, OH
b Department of Interventional Neuroradiolog, Case Western University Medical Center, Cleveland, OH
c Department of Neurological Surgery, Case Western University Medical Center, Cleveland, OH
d Division of Neurological Surgery, Duke University Health System, Durham, NC
e Division of Interventional Neuroradiology, Duke University Health System, Durham, NC
f Division of Interventional Vascular Radiology, Duke University Health System, Durham, NC
Address correspondence to Osama O. Zaidat, MD, MSc, Duke University Medical Center, Box 3808, Durham, NC 27710
BACKGROUND AND PURPOSE: The effect of vessel patency, following recombinant tissue plasminogen activator (rtPA) administration, on clinical outcome in acute ischemic stroke (AIS) has been controversial. We studied the effect of recanalization following intraarterial (IA) and intravenous/IA (IV/IA) rtPA on clinical outcome in AIS.
METHODS: Recanalization was classified angiographically as complete (as compared with unoccluded vessel, thrombolysis in myocardial infarction classification [TIMI] 3), none (with no change from prethrombolysis, TIMI 0), and partial (when a change in the flow from baseline was noted, TIMI 1–2). Outcomes were symptomatic intracranial hemorrhage (sICH), 90-day modified Rankin scale (
2 as a good outcome), and 3-month mortality.
RESULTS: Ninety-six patients had either combined IV/IA (41) or IA (55) rtPA for AIS during a 7-year period. Any recanalization occurred in 69%; 55% of those had a good outcome versus 23% in the rest (Odds ratio = 3.9; 95% confidence interval [CI] = 1.4–11.2; P = .007). Only 24% had complete recanalization; 74% had a good outcome versus 36% in the nonrecanalization group (OR = 5.1; 95% CI = 1.6–16.8; P = .002). When adjusted to time to therapy and vessel occluded, these results lessened but remained significant. The sICH rate with any recanalization was 7.6% versus 13.3% in patients with persistent clot (relative risk (RR) = 0.6; 95% CI = 0.2–2.0; P = .45). Death occurred in 19.7% of those whose vessels recanalized versus 33.3% in the rest (RR = 0.56; 95% = 0.26–1.19; P = .2).
CONCLUSION: A total of 24% and 69% of patients had complete and any recanalization, respectively, following endovascular rtPA therapy of AIS. The degree of recanalization was directly related to time to therapy and associated with good clinical outcome without an increase in the rate of adverse effect.
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