Evgenia Klourfeld, Presenter: Nothing to Disclose

Petra Cimflova, Abstract Co-Author: Nothing to Disclose

Miroslav Skorna MD, Abstract Co-Author: Nothing to Disclose

Josep Puig Alcantara MD, Abstract Co-Author: Nothing to Disclose

Daruish Dowlatshahi MD, Abstract Co-Author: Nothing to Disclose

Ana Calleja Sanz, Abstract Co-Author: Nothing to Disclose

Sung-Il Sohn, Abstract Co-Author: Nothing to Disclose

Alexander Yves Poppe, Abstract Co-Author: Nothing to Disclose

Seong Hwan Ahn, Abstract Co-Author: Nothing to Disclose

Negar Asdaghi, Abstract Co-Author: Nothing to Disclose

Albert Jin, Abstract Co-Author: Nothing to Disclose

Teri Stewart, Abstract Co-Author: Nothing to Disclose

Bijoy Menon MBBS, MD, Abstract Co-Author: Nothing to Disclose

Andrew Demchuk MD, Abstract Co-Author: Nothing to Disclose

Recanalization is associated with a 4 fold increase in good outcomes in acute ischemic stroke. CTA has become the clinical and research standard of cerebrovascular assessment. Currently, there is no validated standardized CTA recanalization scoring system. We aimed to develop a CTA-based recanalization scale, and test the reliability of its components.

Data is from INTERRSeCT, a multi-center prospective study, examining clot characteristics associated with early recanalization. Three raters assessed CTAs of 30 randomly selected patients at baseline and 2-6h later. Baseline scans were scored for site of primary intracranial arterial occlusive lesion (PIAOL), residual flow through PIAOL and distal thrombus burden (DTB). Recanalization was assessed on follow-up CTA using PIAOL debulking, change in residual flow, and DTB. A CTA Recanalization Score (CTARS) consisting of 8 categories was used to summarize recanalization of PIAOL and its distal vasculature. Reliability was quantified using kappa (weighted when appropriate)

Agreement on PIAOL location varied from excellent proximally (ICA, M1, proximal M2) to poor for more distal sites. Agreement was moderate to substantial on residual flow (Kw=0.67, 0.49, 0.55), and fair to moderate on DTB (Kw=0.41, 0.17, 0.31) at baseline. Reliability was excellent for PIAOL debulking (Kw=0.87, 0.90, 0.92), residual flow change (Kw=0.91, 0.88, 0.86), and moderate to substantial for follow-up DTB (Kw=0.78, 0.43, 0.51). Near perfect agreement was obtained on final CTARS (Kw=0.90, 0.96, 0.88).

CTARS is a reliable method of assessing recanalization of PIAOL and its' distal vasculature. Future studies should focus on prospective scale validation and performance with other imaging modalities.

A reliable CTA recanalization assessment method will help in comparing novel thrombolytic agents vs. current standard of care in acute stroke management.

Klourfeld, E, Cimflova, P, Skorna, M, Puig Alcantara, J, Dowlatshahi, D, Calleja Sanz, A, Sohn, S, Poppe, A, Ahn, S, Asdaghi, N, Jin, A, Stewart, T, Menon, B, Demchuk, A, CTA Recanalization Score – A Reliable Measure of Recanalization.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014337.html