Open AccessEarly Recanalization Postintravenous Thrombolysis in Ischemic Stroke with Large Vessel Occlusion: A Digital Subtraction Angiography Study
Author(s) -
Mao YiTing,
Mitchell Peter,
Churilov Leonid,
Dowling Richard,
Dong Qiang,
Yan Bernard
Publication year - 2016
Publication title -
cns neuroscience and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 69
eISSN - 1755-5949
pISSN - 1755-5930
DOI - 10.1111/cns.12549
Subject(s) - medicine , digital subtraction angiography , thrombolysis , modified rankin scale , middle cerebral artery , interquartile range , stroke (engine) , basilar artery , internal carotid artery , angiography , occlusion , odds ratio , radiology , cardiology , ischemic stroke , ischemia , mechanical engineering , myocardial infarction , engineering
Summary Aims We aimed to evaluate early recanalization postintravenous (i.v.) tissue plasminogen activator (t‐PA) by digital subtraction angiography (DSA) in acute ischemic stroke (AIS) with large vessel occlusion (LVO). Methods We performed baseline CT angiography to identify LVO in AIS. Recanalization pre‐ and post‐intra‐arterial therapy (IAT) was categorized to none, partial, and global recanalization (GR). Modified Rankin Scale score ≤2 at 3 months was considered a favorable outcome. Results Among 1610 patients with AIS, 286 received IV t‐PA. Of these, 55 patients with LVO were included. The median time from IV t‐PA to DSA was 120 min (interquartile range, 79–152). Recanalization post‐IV t‐PA was observed in seven patients (12.7%). By occlusion sites, the recanalization rates were as follows: extracranial internal carotid artery 2 of 14 (14.3%); intracranial internal carotid artery 3 of 24 (12.5%); M1 of middle cerebral artery 3 of 39 (7.7%); M2 of middle cerebral artery 1 of 40 (2.5%); vertebral artery 0 of 4; and basilar artery 0 of 7. GR post‐IAT was associated with favorable outcomes (odds ratio: 8.6; 95% confidence interval, 1.5–48.0; P = 0.014). Conclusion Early recanalization assessed by DSA post‐IV t‐PA is rarely observed in acute ischemic stroke patients with LVO.