Abstract T MP23: M2 Vessel Diameter and Clot Length Influence Degree of Successful Recanalization Within 6 Hours Of Iv-tpa Treatment
Introduction: Occlusions of the M2 branch show recanalization rates of 44% at 2 hours post treatment with IV-tPA when measured by TCD however no studies have looked at recanalization rates in early (<6h) time windows with angiography.
Objectives: We aim to define recanalization rates for M2 occlusions with IV-tPA in an early time window (<6H) using CTA and explore the role of M2 size and clot length in predicting successful recanalization.
Methods: patients with acute intracranial occlusions were prospectively enrolled into the InterrSect study and had a baseline CTA at time of inclusion and within 6 hours of receiving IV-tPA. Baseline CTA was analyzed on the OSIRIX platform; two experienced raters measured M2 diameter at the proximal clot interface and M1 diameter at mid-segment on axial MIP images. Two experienced raters independently analyzed clot length and recanalization on follow-up CTA (75/81) and first run angiograms (6/81). Clot length was stratified as (long>15mm) or (short0.8) or (Low <= 0.8).
Results: 81 patients with M2 occlusions treated with IV-tPA were included in the study. Successful recanalization was achieved in 63.5% of patients with IV-tPA within 4-6 hours of bolus. Figure1 demonstrates a significant relationship between clot lengths, ratio M2/M1 to early recanalization (Fishers exact p= 0.035). Using general linear modelling, the rate of early recanalization is 1.9 times (p= 0.018, 95%CI 1.12-3.37) higher in the Short clot-Low M2/M1 ratio group when compared to the group with long clot and high ratio after adjusting for age.
Conclusion: Small M2 clots treated with IV-tPA achieve early recanalization exceeding 80%; large M2 clots in comparison achieve recanalization rates below 50%. The later clots could be included in clinical trials comparing IV with endovascular therapy.
Author Disclosures: J.A. Desai: None. P.A. Burns: None. B.K. Menon: None. S. Mishra: None. M. Goyal: Speakers' Bureau; Modest; Covidien EV3. Research Grant; Significant; Institutional grant for ESCAPE trial from Covidien EV3. Consultant/Advisory Board; Significant; Covidien EV3 for help with design and execution of SWIFT PRIME. S. Sohn: None. D. Dowlatshahi: None. A.I. Calleja Sanz: None. J.P. Alcantara: None. A.Y. Jin: None. J. Boulanger: None. A.Y. Poppe: None. F. Moreau: None. T. Asil: None. Y. Hwang: None. S.H. Ahn: None. N. Asdaghi: None. R. Mikulik: None. M.D. Hill: None. A.M. Demchuk: None.
- © 2014 by American Heart Association, Inc.