Abstract 114: Interim Recanalization in Acute Ischemic Stroke Patients Selected for Endovascular Treatment by CT Angiography
Background: In the Interventional Management of Stroke III trial, there was a 35% incidence of improvement or resolution of occlusion in IV alteplase treated patients selected by computed tomographic (CT) angiogram for endovascular treatment.
Objective: To determine the frequency of resolution or change in occlusion site in patients with CT angiogram demonstrated occlusion in IV alteplase treated or untreated patients.
Methods: All acute ischemic stroke patients who underwent a computed tomographic (CT) angiogram and subsequently underwent endovascular treatment were included. The CT angiogram images were reviewed by an independent reviewer to determine presence and location of arterial occlusion and severity of occlusion was classified by a previously described grading scheme. The cerebral angiographic images were reviewed for similar endpoints. Clinical outcome at discharge was determined using modified Rankin scale (mRS).
Results: CT angiogram was performed in 151 patients (mean age ± SD of 64±16 years) prior to endovascular treatment. The mean interval (±SD) between CT angiogram and cerebral angiogram was 190±10 (min) and 66 of 151 patients (43.7%) received IV alteplase prior to cerebral angiography. The rate of any recanalization prior to cerebral angiography was 28 of 151 (18.5%) and no change in occlusion was found in 92 (60.9%) patients whereas 31 (20.5%) patients showed worsening in occlusion based on the grading scheme. The rate of interim recanalization was similar in IV alteplase treated patients versus untreated patients (19.6% vs % 17.6, p= 0.7) The frequency of Angiographic recanalization following endovascular treatment was similar in both groups (67.8% versus 71.2%, p=0.7), After adjusting for age and initial NIHSS score strata, interim recanalization was not associated with higher rate of mRS 0-2 at discharge (OR 1.9, 95% CI 0.7-5.2).
Conclusions: A relatively high proportion of patients have interim recanalization between CT angiogram and cerebral angiogram in acute ischemic stroke patients selected for endovascular treatment.
Author Disclosures: M.H. Qureshi: None. F. Siddiq: None. D. Kaint: None. A.I. Qureshi: None.
- © 2014 by American Heart Association, Inc.