title: Improving the Prediction of Spontaneous and Post-thrombolytic Recanalization in Ischemic Stroke Patients.
abstract: BACKGROUND
  Endovascular treatment for acute ischemic stroke patients was recently shown to improve recanalization rates and clinical outcome in a well-defined study population. Intravenous thrombolysis (IVT) alone is insufficiently effective to recanalize in certain patients or of little value in others. Accordingly, we aimed at identifying predictors of recanalization in patients treated with or without IVT.
  
  
  METHODS
  In the observational Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry, we selected those stroke patients (1) with an arterial occlusion on computed tomography angiography (CTA) imaging, (2) who had an arterial patency assessment at 24 hours (CTA/magnetic resonance angiography/transcranial Doppler), and (3) who were treated with IVT or had no revascularization treatment. Based on 2 separate logistic regression analyses, predictors of spontaneous and post-thrombolytic recanalization were generated.
  
  
  RESULTS
  Partial or complete recanalization was achieved in 121 of 210 (58%) thrombolyzed patients. Recanalization was associated with atrial fibrillation (odds ratio , 1.6; 95% confidence interval, 1.2-3.0) and absence of early ischemic changes on CT (1.1, 1.1-1.2) and inversely correlated with the presence of a significant extracranial (EC) stenosis or occlusion (.6, .3-.9). In nonthrombolyzed patients, partial or complete recanalization was significantly less frequent (37%, P < .01). The recanalization was independently associated with a history of hypercholesterolemia (2.6, 1.2-5.6) and the proximal site of the intracranial occlusion (2.5, 1.2-5.4), and inversely correlated with a decreased level of consciousness (.3, .1-.8), and EC (.3, .1-.6) and basilar artery pathology (.1, .0-.6).
  
  
  CONCLUSIONS
  Various clinical findings, cardiovascular risk factors, and arterial pathology on acute CTA-based imaging are moderately associated with spontaneous and post-thrombolytic arterial recanalization at 24 hours. If confirmed in other studies, this information may influence patient selection toward the most appropriate revascularization strategy.
authors.affiliation: Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Department of Neurology, University Hospital Antwerp, Edegem, Belgium. Electronic address: peter.vanacker@chuv.ch.
authors.forename: Peter
authors.initials: P
authors.lastname: Vanacker
authors.affiliation: Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Lambrou
authors.affiliation: Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Eskandari
authors.affiliation: Department of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Ntaios
authors.affiliation: Department of Neurology, University Hospital Antwerp, Edegem, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Cras
authors.affiliation: Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Maeder
authors.affiliation: Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Meuli
authors.affiliation: Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
keywords: CT angiography; IV thrombolysis; Ischemic stroke; acute stroke management; recanalization