title: Prediction of recanalization in acute stroke patients receiving intravenous and endovascular revascularization therapy.
abstract: OBJECTIVE
  The study aims to assess the recanalization rate in acute ischemic stroke patients who received no revascularization therapy, intravenous thrombolysis, and endovascular treatment, respectively, and to identify best clinical and imaging predictors of recanalization in each treatment group.
  
  
  METHODS
  Clinical and imaging data were collected in 103 patients with acute ischemic stroke caused by anterior circulation arterial occlusion. We recorded demographics and vascular risk factors. We reviewed the noncontrast head computed tomographies to assess for hyperdense middle cerebral artery and its computed tomography density. We reviewed the computed tomography angiograms and the raw images to determine the site and degree of arterial occlusion, collateral score, clot burden score, and the density of the clot. Recanalization status was assessed on recanalization imaging using Thrombolysis in Myocardial Ischemia. Multivariate logistic regressions were utilized to determine the best predictors of outcome in each treatment group.
  
  
  RESULTS
  Among the 103 study patients, 43 (42%) received intravenous thrombolysis, 34 (33%) received endovascular thrombolysis, and 26 (25%) did not receive any revascularization therapy. In the patients with intravenous thrombolysis or no revascularization therapy, recanalization of the vessel was more likely with intravenous thrombolysis (P = 0·046) and when M1/A1 was occluded (P = 0·001). In this subgroup of patients, clot burden score, cervical degree of stenosis (North American Symptomatic Carotid Endarterectomy Trial), and hyperlipidemia status added information to the aforementioned likelihood of recanalization at the patient level (P < 0·001). In patients with endovascular thrombolysis, recanalization of the vessel was more likely in the case of a higher computed tomography angiogram clot density (P = 0·012), and in this subgroup of patients gender added information to the likelihood of recanalization at the patient level (P = 0·044).
  
  
  CONCLUSIONS
  The overall likelihood of recanalization was the highest in the endovascular group, and higher for intravenous thrombolysis compared with no revascularization therapy. However, our statistical models of recanalization for each individual patient indicate significant variability between treatment options, suggesting the need to include this prediction in the personalized treatment selection.
authors: Department of Neurology, Military General Hospital of Beijing PLA, Beijing, China; Department of Radiology, Neuroradiology Division, University of Virginia, Charlottesville, VA, USA.
authors: Guangming
authors: G
authors: Zhu
authors: Patrik
authors: P
authors: Michel
authors: Tudor
authors: T
authors: Jovin
authors: James T
authors: JT
authors: Patrie
authors: Wenjun
authors: W
authors: Xin
authors: Ashraf
authors: A
authors: Eskandari
authors: Weiwei
authors: W
authors: Zhang
authors: Max
authors: M
authors: Wintermark
mesh_terms: D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents
keywords: CT angiography; computed tomography; predictive model; recanalization; stroke