Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion

• Published in: Journal of Stroke
• Main Authors: Young Dae Kim, Hyo Suk Nam, Joonsang Yoo, Hyungjong Park, Sung-Il Sohn, Jeong-Ho Hong, Byung Moon Kim, Dong Joon Kim, Oh Young Bang, Woo-Keun Seo, Jong-Won Chung, Kyung-Yul Lee, Yo Han Jung, Hye Sun Lee, Seong Hwan Ahn, Dong Hoon Shin, Hye-Yeon Choi, Han-Jin Cho, Jang-Hyun Baek, Gyu Sik Kim, Kwon-Duk Seo, Seo Hyun Kim, Tae-Jin Song, Jinkwon Kim, Sang Won Han, Joong Hyun Park, Sung Ik Lee, JoonNyung Heo, Jin Kyo Choi, Ji Hoe Heo
• Format: Article
• Language: English
• Published: Korean Stroke Society 2021-05-01
• Subjects: ischemia; stroke; thrombosis; thrombolysis; reperfusion
• Online Access: http://www.j-stroke.org/upload/pdf/jos-2020-03622.pdf

Background and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. Methods Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. Results Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). Conclusions The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.