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RT Journal Article
SR Electronic
T1 Role of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based “Benefit of Recanalization” Model
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1471
OP 1475
DO 10.3174/ajnr.A1153
VO 29
IS 8
A1 Rosenthal, E.S.
A1 Schwamm, L.H.
A1 Roccatagliata, L.
A1 Coutts, S.B.
A1 Demchuk, A.M.
A1 Schaefer, P.W.
A1 Gonzalez, R.G.
A1 Hill, M.D.
A1 Halpern, E.F.
A1 Lev, M.H.
YR 2008
UL http://www.ajnr.org/content/29/8/1471.abstract
AB BACKGROUND AND PURPOSE: In acute middle cerebral artery (MCA) stroke, CT angiographic (CTA) source images (CTA-SI) identify tissue likely to infarct despite early recanalization. This pilot study evaluated the impact of recanalization status on clinical and radiologic predictors of patient outcomes.MATERIALS AND METHODS: Of 44 patients undergoing CT/CTA within 6 hours of developing symptoms of proximal MCA ischemia, 19 patients achieved complete proximal MCA (MCA M1) recanalization. Admission National Institutes of Health Stroke Scale (NIHSS) score, onset-to-imaging time, CTA-SI Alberta Stroke Program Early CT Score, MCA M1 occlusion, cerebrovascular collaterals score, and CTA-SI lesion volume were correlated with 3- to 6-month follow-up modified Rankin Scale (mRS). We developed 2 stepwise regression models: one for patients with complete MCA M1 recanalization and one for patients without complete recanalization.RESULTS: Complete and incomplete recanalization groups had similar median admission NIHSS scores (19 versus 19) and mean onset-to-imaging times (2.3 versus 1.9 hours) but different proportions of patients achieving mRS scores 0–2 (74% versus 40%; P = .04). The only independent predictors of clinical outcome in patients with complete recanalization were onset-to-imaging time and admission CTA-SI lesion volume (total model R2 = 0.75; P = .01). The only independent predictors of outcome in patients with incomplete recanalization were admission CTA-SI lesion volume and NIHSS score (total model R2 = 0.66; P = .007).CONCLUSION: Regardless of recanalization status, admission CTA-SI lesion volume was associated with clinical outcome. Recanalization status did, however, affect which variables in addition to CTA-SI volume significantly impacted clinical outcome: time with complete recanalization and NIHSS with incomplete recanalization. This finding may support the development of a model predicting the potential clinical benefit expected with early successful recanalization.