title: Early Recanalization Postintravenous Thrombolysis in Ischemic Stroke with Large Vessel Occlusion: A Digital Subtraction Angiography Study.
abstract: We aimed to evaluate early recanalization postintravenous (i.v.) tissue plasminogen activator (t-PA) by digital subtraction angiography (DSA) in acute ischemic stroke (AIS) with large vessel occlusion (LVO).
  
  
  
  We performed baseline CT angiography to identify LVO in AIS. Recanalization pre- and post-intra-arterial therapy (IAT) was categorized to none, partial, and global recanalization (GR). Modified Rankin Scale score ≤2 at 3 months was considered a favorable outcome.
  
  
  
  Among 1610 patients with AIS, 286 received IV t-PA. Of these, 55 patients with LVO were included. The median time from IV t-PA to DSA was 120 min (interquartile range, 79-152). Recanalization post-IV t-PA was observed in seven patients (12.7%). By occlusion sites, the recanalization rates were as follows: extracranial internal carotid artery 2 of 14 (14.3%); intracranial internal carotid artery 3 of 24 (12.5%); M1 of middle cerebral artery 3 of 39 (7.7%); M2 of middle cerebral artery 1 of 40 (2.5%); vertebral artery 0 of 4; and basilar artery 0 of 7. GR post-IAT was associated with favorable outcomes (odds ratio: 8.6; 95% confidence interval, 1.5-48.0; P = 0.014).
  
  
  
  Early recanalization assessed by DSA post-IV t-PA is rarely observed in acute ischemic stroke patients with LVO.
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Mao
authors.affiliation: Department of Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic., Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia.
authors.forename: Leonid
authors.initials: L
authors.lastname: Churilov
authors.affiliation: Department of Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic., Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Dowling
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Dong
authors.affiliation: Department of Neurology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic., Australia.
authors.forename: Bernard
authors.initials: B
authors.lastname: Yan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000150:complications; D002536:Cerebral Arteries / Q000601:surgery; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Digital subtraction angiography; Ischemic stroke; Large vessel occlusion; Recanalization; Thrombolysis