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RT Journal Article
SR Electronic
T1 Factors Influencing Clinically Meaningful Recanalization after IV-rtPA in Acute Ischemic Stroke
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 146
OP 152
DO 10.3174/ajnr.A3169
VO 34
IS 1
A1 Murphy, A.
A1 Symons, S.P.
A1 Hopyan, J.
A1 Aviv, R.I.
YR 2013
UL http://www.ajnr.org/content/34/1/146.abstract
AB 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 &lt; .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. AICAkaike information criteriaASPECTSAlberta Stroke Program Early CT scoreCBSclot-burden scoreCMRclinically meaningful recanalizationIAintra-arterialIQRinterquartile rangeMIPmaximum intensity projection