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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 28:164-167, January 2007
© 2007 American Society of Neuroradiology

INTERVENTIONAL

Pretreatment Ipsilateral Regional Cortical Blood Flow Influences Vessel Recanalization in Intra-Arterial Thrombolysis for MCA Occlusion

T.G. Jovin^a,d, R. Gupta^a, M.B. Horowitz^b, S.Z. Grahovac^c, C.A. Jungreis^e, L. Wechsler^a, J.M. Gebel^f and H. Yonas^g

^a Department of Neurology and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
^b Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
^c Department of Neuroradiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
^d Veterans Affairs Health Systems Pittsburgh, Pittsburgh, Pa
^e Department of Neuroradiology, Temple University, Philadelphia, Pa
^f Neurological Associates, Louisville, Ky
^g Department of Neurosurgery, University of New Mexico, Albuquerque, NM

Address correspondence to Tudor G. Jovin, MD, University of Pittsburgh Medical Center, Stroke Institute, 200 Lothrop St, Suite C-400, Pittsburgh, PA 15213; e-mail: jovintg{at}upmc.edu

BACKGROUND AND PURPOSE: The aim of acute stroke interventions is to achieve recanalization of the target occluded artery. We sought to determine whether pretreatment cortical cerebral blood flow (CBF) was associated with vessel recanalization in patients undergoing intra-arterial therapy.

METHODS: This is a retrospective analysis of patients who underwent a quantitative xenon CT blood flow study and were noted to have a documented M1 middle cerebral artery (MCA) or carotid terminus occlusion less than 6 hours from symptom onset between January 1997 and April 2001. Twenty-three patients who underwent intra-arterial thrombolysis were included in the analysis. Univariate and multivariate analyses were performed to determine whether pretherapy CBF was correlated to the likelihood of recanalization.

RESULTS: A total of 23 patients were studied in this analysis with a median age of 69 (range 32–81) and median National Institutes of Health Stroke Score of 19 (range, 8–22). Twelve patients (52%) underwent combined intravenous/intra-arterial therapy, and 11 patients (48%) were treated with intra-arterial thrombolytics alone. Successful vessel recanalization (Thrombolysis in Myocardial Infarction classification 2 or 3 flow) occurred in 13 patients (57%). The only variable associated with recanalization in multivariate modeling was mean ipsilateral MCA CBF (odds ratio, 1.25; 95% confidence interval, 1.01–1.54; P = .035). A receiver operating characteristic curve was generated, and a mean ipsilateral MCA CBF threshold of 18 mL/100 g/min was found to be the threshold for successful recanalization.

CONCLUSIONS: Our study suggests that patients with higher mean ipsilateral MCA CBF are more likely to recanalize. The threshold for successful revascularization may be 18 mL/100 g/min. Further study is required to determine whether pretreatment CBF is related to recanalization success.

This article has been cited by other articles:

				K. Uchino and D. C. Anderson Better late than never?: The story of arterial recanalization in acute ischemic stroke Neurology, April 24, 2007; 68(17): 1335 - 1336. [Full Text] [PDF]