Early Reperfusion Rates with IV tPA are Determined by CTA Clot Characteristics
- S.M. Mishra; J. Dykeman; T.T. Sajobi; A. Trivedi; M. Almekhlafi; S.I. Sohn; S. Bal; E. Qazi; A. Calleja; M. Eesa; M. Goyal; A.M. Demchuk; B.K. Menon
- Dept. of Neurology (신경과학)
- Issue Date
- AJNR, American Journal of Neuroradiology, Vol.35(12) : 2265-2272, 2014
- BACKGROUND AND PURPOSE: An ability to predict early reperfusion with IV tPA in patients with acute ischemic stroke and intracranial clots
can help clinicians decide if additional intra-arterial therapy is needed or not.Weexplored the association between novel clot characteristics on
baseline CTA and early reperfusion with IV tPA in patients with acute ischemic stroke by using classification and regression tree analysis.
MATERIALS AND METHODS: Data are from patients with acute ischemic stroke and proximal anterior circulation occlusions from the Calgary
CTA data base (2003–2012) and the Keimyung Stroke Registry (2005–2009). Patients receiving IV tPA followed by intra-arterial therapy were
included. Clot location, length, residualflowwithin the clot, ratio of contrast Hounsfield units pre- and postclot, and the M1 segment origin to the
proximal clot interface distance were assessed on baseline CTA. Early reperfusion (TICI 2a and above) with IV tPA was assessed on the first
RESULTS: Two hundred twenty-eight patients (50.4% men; median age, 69 years; median baseline NIHSS score, 17) fulfilled the inclusion
criteria. Median symptom onset to IV tPA time was 120 minutes (interquartile range 70 minutes); median IV tPA to first angiography time
was 70.5 minutes (interquartile range 62 minutes). Patients with residual flow within the clot were 5 times more likely to reperfuse than
those without it. Patients with residual flow and a shorter clot length ( 15 mm) were most likely to reperfuse (70.6%). Patients with clots
in the M1 MCA without residual flow reperfused more if clots were distal and had a clot interface ratio in Hounsfield units of 2 (36.8%).
Patients with proximal M1 clots without residual flow reperfused 8% of the time. Carotid-T/-L occlusions rarely reperfused (1.7%). Interrater
reliability for these clot characteristics was good.
CONCLUSIONS: Our study shows that clot characteristics on CTA help physicians estimate a range of early reperfusion rates with IV tPA.
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- 1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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