Alexander D. Horsch MD, MRCS, Presenter: Nothing to Disclose

Jan Willem Dankbaar MD, PhD, Abstract Co-Author: Nothing to Disclose

Yolanda Van Der Graaf, Abstract Co-Author: Nothing to Disclose

Willem P. Mali MD, PhD, Abstract Co-Author: Nothing to Disclose

Birgitta Katinka Velthuis MD, Abstract Co-Author: Research Consultant, Koninklijke Philips NV Speakers Bureau, Koninklijke Philips NV

Acute ischemic stroke studies emphasize a difference between reperfusion and recanalization but predictors of reperfusion have not been elucidated. This study aims to identify predictors of reperfusion and to investigate the relation between recanalization and reperfusion.

From the XXX trial 178 patients were selected with a middle cerebral artery territory perfusion deficit on admission CT perfusion (CTP) and complete day 3 follow-up CTP and CT-angiography (CTA). Reperfusion and recanalization were evaluated on the follow-up imaging. The association between reperfusion and recanalization was calculated using absolute and relative risks. Patient admission and treatment characteristics as well as admission CT imaging parameters regarding occlusion site and stroke severity were collected. Their association with complete reperfusion was analyzed using logistic regression.

Absolute risk for complete reperfusion was 0.60 in the complete recanalization group and 0.23 in the incomplete recanalization group, with a relative risk of 2.60 (CI 1.63-4.13), but around 40% showed a discrepancy between recanalization and reperfusion status. Lower clot burden (OR 1.35, CI 1.14-1.58), more distal thrombus location (OR 2.28, CI 1.18-4.39) and good collateral score (OR 2.84, CI 1.34-6.02) increased the odds of complete reperfusion whilst higher NIHSS score (OR 0.95, CI 0.90-1.00), larger infarct core size (OR 0.32, CI 0.15-0.69) and larger total ischemic area (OR 0.31, CI 0.15-0.67 for 2001-5000 mm2 and OR 0.16, CI 0.07-0.37 for >5000 mm2) decreased the odds of complete reperfusion. None of the patients with ipsilateral intracranial ICA occlusion showed complete reperfusion.

Recanalization and reperfusion are strongly related but not always equivalent in acute ischemic stroke. Lower clot burden, distal thrombus location, collateral score, NIHSS score, infarct core size and total ischemic area are predictors of reperfusion.

Lower clot burden, distal thrombus location, collateral score, NIHSS score, infarct core size and total ischemic area are predictors of reperfusion and can be used to aid treatment decisions in acute ischemic stroke patients.

Horsch, A, Dankbaar, J, Van Der Graaf, Y, Mali, W, Velthuis, B, Predictors of Reperfusion in Acute Ischemic Stroke Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015026.html