J Stroke.  2021 May;23(2):244-252. 10.5853/jos.2020.03622.

Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion

Affiliations
  • 1Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
  • 3Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
  • 4Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
  • 5Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 6Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
  • 7Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
  • 8Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
  • 9Department of Neurology, Chosun University College of Medicine, Gwangju, Korea
  • 10Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
  • 11Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
  • 12Department of Neurology, Pusan National University School of Medicine, Busan, Korea
  • 13Department of Neurology, National Medical Center, Seoul, Korea
  • 14Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 15Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
  • 16Department of Neurology, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Sanbon, Korea
  • 17Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 18Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
  • 19Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea
  • 20Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
  • 21Department of Neurology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

Abstract

Background and Purpose
We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion.
Methods
Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization.
Results
Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032).
Conclusions
The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

Keyword

Ischemia; Stroke; Thrombosis; Thrombolysis; Reperfusion
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