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.
Key Words
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Article info
Publication history
Published online: May 23, 2015
Accepted:
April 1,
2015
Received in revised form:
March 17,
2015
Received:
January 27,
2015
Footnotes
This research is supported by grants from the Swiss Cardiology foundation (P.M.), CardioMet-CHUV (P.M.) and a scholarship of the European Neurological Society (P.V.). No potential conflict of interests.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.04.002
Copyright
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
