title: Improving prediction of recanalization in acute large-vessel occlusive stroke.
abstract: BACKGROUND
  Recanalization in acute ischemic stroke with large-vessel occlusion is a potent indicator of good clinical outcome.
  
  
  OBJECTIVE
  To identify easily available clinical and radiologic variables predicting recanalization at various occlusion sites.
  
  
  METHODS
  All consecutive, acute stroke patients from the Acute STroke Registry and Analysis of Lausanne (2003-2011) who had a large-vessel occlusion on computed tomographic angiography (CTA) (< 12 h) were included. Recanalization status was assessed at 24 h (range: 12-48 h) with CTA, magnetic resonance angiography, or ultrasonography. Complete and partial recanalization (corresponding to the modified Treatment in Cerebral Ischemia scale 2-3) were grouped together. Patients were categorized according to occlusion site and treatment modality.
  
  
  RESULTS
  Among 439 patients, 51% (224) showed complete or partial recanalization. In multivariate analysis, recanalization of any occlusion site was most strongly associated with endovascular treatment, including bridging therapy (odds ratio [OR] 7.1, 95% confidence interval [CI] 2.2-23.2), and less so with intravenous thrombolysis (OR 1.6, 95% CI 1.0-2.6) and recanalization treatments performed beyond guidelines (OR 2.6, 95% CI 1.2-5.7). Clot location (large vs. intermediate) and tandem pathology (the combination of intracranial occlusion and symptomatic extracranial stenosis) were other variables discriminating between recanalizers and non-recanalizers. For patients with intracranial occlusions, the variables significantly associated with recanalization after 24 h were: baseline National Institutes of Health Stroke Scale (NIHSS) (OR 1.04, 95% CI 1.02-1.1), Alberta Stroke Program Early CT Score (ASPECTS) on initial computed tomography (OR 1.2, 95% CI 1.1-1.3), and an altered level of consciousness (OR 0.2, 95% CI 0.1-0.5).
  
  
  CONCLUSIONS
  Acute endovascular treatment is the single most important factor promoting recanalization in acute ischemic stroke. The presence of extracranial vessel stenosis or occlusion decreases recanalization rates. In patients with intracranial occlusions, higher NIHSS score and ASPECTS and normal vigilance facilitate recanalization. Clinical use of these predictors could influence recanalization strategies in individual patients.
authors.affiliation: Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland; Department of Neurology, University Hospital Antwerp, Edegem, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Vanacker
authors.forename: D
authors.initials: D
authors.lastname: Lambrou
authors.forename: A
authors.initials: A
authors.lastname: Eskandari
authors.forename: P
authors.initials: P
authors.lastname: Maeder
authors.forename: R
authors.initials: R
authors.lastname: Meuli
authors.forename: G
authors.initials: G
authors.lastname: Ntaios
authors.forename: P
authors.initials: P
authors.lastname: Michel
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000628:therapy*; D002533:Cerebral Angiography; D003952:Diagnostic Imaging / Q000379:methods; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012042:Registries; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D013557:Switzerland; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: mechanical thrombolysis; neuroimaging; stroke; tissue-type plasminogen activator; treatment outcome