Assessment of recanalization after intra-arterial thrombolysis in patients with acute ischemic stroke : proposed modification of the qureshi grading system.
OBJECTIVE
We aimed to investigate the correlation between the success of recanalization and a modified version of the Qureshi grading system in acute ischemic stroke patients.


METHODS
We retrospectively analyzed the intra-arterial thrombolysis (IAT) records of 37 patients who were evaluated by Thrombolysis in Myocardial Infarction (TIMI) and a modified version of the Qureshi grading systems as follows : 1) post-IAT Qureshi grade, 2) modified Δ Qureshi grade : pre-IAT group grade - post-IAT group grade (grade 1 : Qureshi grades 0-2 and grade 2 : Qureshi grade 3-5) and 3) Δ Qureshi grade (post-IAT Qureshi grade - pre-IAT Qureshi grade). Successful recanalization was defined as follows : 1) post-IAT TIMI grades 2 and 3, 2) post-IAT Qureshi grade 0-2, 3) modified Δ Qureshi grade=1, and 4) Δ Qureshi grade of ≥2 and/or post-IAT Qureshi grade=0. We investigated the correlation between the post-IAT TIMI grade and the modified Qureshi grade and also compared the various grading systems with modified Rankin Scale scores for evaluating the clinical outcome at 3 months.


RESULTS
The post-IAT Qureshi grade and Δ Qureshi grade and/or post-IAT Qureshi grade were significantly correlated with the TIMI grade (γ=0.976 and, 0.942, respectively). Further, post-IAT Qureshi grade and Δ Qureshi grade and/or post-IAT Qureshi grade showed a significantly stronger association with clinical outcome than did the post-IAT TIMI grade (p=0.001 and, 0.000 vs. 0.083, respectively).


CONCLUSIONS
Our preliminary results suggest that the modified Qureshi grading system is a useful tool for assessing the success of recanalization after IAT.
Department of Neurosurgery, Eulji University Eulji Hopsital, Seoul, Korea.
Jae Hoon
JH
Kim
Hee In
HI
Kang
Byung Gwan
BG
Moon
Seung Jin
SJ
Lee
Joo Seung
JS
Kim