Improving the Prediction of Spontaneous and Post-thrombolytic Recanalization in Ischemic Stroke Patients

Peter Vanacker; Dimitris Lambrou; Ashraf Eskandari; George Ntaios; Patrick Cras; Philippe Maeder; Reto Meuli; Patrik Michel

doi:10.1016/j.jstrokecerebrovasdis.2015.04.002

Improving the Prediction of Spontaneous and Post-thrombolytic Recanalization in Ischemic Stroke Patients

J Stroke Cerebrovasc Dis. 2015 Aug;24(8):1781-6. doi: 10.1016/j.jstrokecerebrovasdis.2015.04.002. Epub 2015 May 23.

Authors

Peter Vanacker¹, Dimitris Lambrou², Ashraf Eskandari², George Ntaios³, Patrick Cras⁴, Philippe Maeder⁵, Reto Meuli⁵, Patrik Michel²

Affiliations

¹ Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Department of Neurology, University Hospital Antwerp, Edegem, Belgium. Electronic address: peter.vanacker@chuv.ch.
² Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
³ Department of Medicine, University of Thessaly, Larissa, Greece.
⁴ Department of Neurology, University Hospital Antwerp, Edegem, Belgium.
⁵ Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

PMID: 26015095
DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.002

Abstract

Background: Endovascular treatment for acute ischemic stroke patients was recently shown to improve recanalization rates and clinical outcome in a well-defined study population. Intravenous thrombolysis (IVT) alone is insufficiently effective to recanalize in certain patients or of little value in others. Accordingly, we aimed at identifying predictors of recanalization in patients treated with or without IVT.

Methods: In the observational Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry, we selected those stroke patients (1) with an arterial occlusion on computed tomography angiography (CTA) imaging, (2) who had an arterial patency assessment at 24 hours (CTA/magnetic resonance angiography/transcranial Doppler), and (3) who were treated with IVT or had no revascularization treatment. Based on 2 separate logistic regression analyses, predictors of spontaneous and post-thrombolytic recanalization were generated.

Results: Partial or complete recanalization was achieved in 121 of 210 (58%) thrombolyzed patients. Recanalization was associated with atrial fibrillation (odds ratio , 1.6; 95% confidence interval, 1.2-3.0) and absence of early ischemic changes on CT (1.1, 1.1-1.2) and inversely correlated with the presence of a significant extracranial (EC) stenosis or occlusion (.6, .3-.9). In nonthrombolyzed patients, partial or complete recanalization was significantly less frequent (37%, P < .01). The recanalization was independently associated with a history of hypercholesterolemia (2.6, 1.2-5.6) and the proximal site of the intracranial occlusion (2.5, 1.2-5.4), and inversely correlated with a decreased level of consciousness (.3, .1-.8), and EC (.3, .1-.6) and basilar artery pathology (.1, .0-.6).

Conclusions: Various clinical findings, cardiovascular risk factors, and arterial pathology on acute CTA-based imaging are moderately associated with spontaneous and post-thrombolytic arterial recanalization at 24 hours. If confirmed in other studies, this information may influence patient selection toward the most appropriate revascularization strategy.

Keywords: CT angiography; IV thrombolysis; Ischemic stroke; acute stroke management; recanalization.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Brain Ischemia / complications*
Endovascular Procedures*
Female
Humans
Magnetic Resonance Angiography
Male
Retrospective Studies
Stroke / etiology*
Stroke / therapy*
Thrombolytic Therapy* / adverse effects
Thrombolytic Therapy* / methods
Tomography Scanners, X-Ray Computed
Treatment Outcome
Ultrasonography, Doppler, Transcranial