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AJNR Am J Neuroradiol. 2013 Jan;34(1):146-52. doi: 10.3174/ajnr.A3169. Epub 2012 Jun 14.

Factors influencing clinically meaningful recanalization after IV-rtPA in acute ischemic stroke.

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1
Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada. amanda.murphy@live.ca

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.

MATERIALS AND METHODS:

One hundred twenty-six consecutive patients with anterior circulation ischemic stroke receiving IV-rtPA were retrospectively reviewed. Imaging included a baseline NCCT and CTA. Recanalization was assessed on a 24-hour CTA. Clinical outcome was determined by the 90-day mRS. CMR was defined as CTA recanalization and a good clinical outcome (mRS ≤2). Logistic regression analysis determined predictors of CMR. The predictive ability of a CMR score was tested with AIC.

RESULTS:

CMR occurred in 29% (36/126). Patients with CMR had fewer neurologic deficits (P = .001) and higher ASPECTS (P = .041) at baseline than those without CMR. Baseline NIHSS score did not predict proximal occlusion (OR 0.959; 95% CI [0.907-1.014]; P = .141). Multivariate analysis showed admission NIHSS score (P = .001) and the site of vessel occlusion (P = .022) to be significant CMR predictors. CMR was significantly less likely in patients with proximal occlusions (ICA, P = .005; proximal M1, P = .021). A CMR score better predicted CMR than either NIHSS or vessel occlusion site alone (P < .0001).

CONCLUSIONS:

Milder baseline stroke deficit and distal vessel occlusion are significant predictors of CMR. A combination of these parameters better predicts CMR than either parameter alone.

PMID:
22700751
DOI:
10.3174/ajnr.A3169
[Indexed for MEDLINE]
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