Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
- Author:
Young Dae KIM
1
;
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
;
Author Information
- Publication Type:Original Article
- From:Journal of Stroke 2021;23(2):244-252
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
