Predictors of reperfusion in patients with acute ischemic stroke

Ischemic stroke studies emphasize a difference between reperfusion and recanalization, but predictors of reperfusion have not been elucidated. The aim of this study was to evaluate the relationship between reperfusion and recanalization and identify predictors of reperfusion. From the Dutch Acute St...

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Published in:American journal of neuroradiology : AJNR 2015-06, Vol.36 (6), p.1056-1062
Main Authors: Horsch, A D, Dankbaar, J W, Niesten, J M, van Seeters, T, van der Schaaf, I C, van der Graaf, Y, Mali, W P Th M, Velthuis, B K
Format: Article
Language:English
Subjects:
Aged
Brain
Brain Ischemia - diagnostic imaging
Cerebral Angiography - methods
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Neovascularization, Physiologic - physiology
Reperfusion Injury - diagnostic imaging
Stroke - diagnostic imaging
Stroke - pathology
Stroke - therapy
Tomography, X-Ray Computed - methods
Treatment Outcome
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Summary:Ischemic stroke studies emphasize a difference between reperfusion and recanalization, but predictors of reperfusion have not been elucidated. The aim of this study was to evaluate the relationship between reperfusion and recanalization and identify predictors of reperfusion. From the Dutch Acute Stroke Study, 178 patients were selected with an MCA territory deficit on admission CTP and day 3 follow-up CTP and CTA. Reperfusion was evaluated on CTP, and recanalization on CTA, follow-up imaging. Reperfusion percentages were calculated in patients with and without recanalization. Patient admission and treatment characteristics and admission CT imaging parameters were collected. Their association with complete reperfusion was analyzed by using univariate and multivariate logistic regression. Sixty percent of patients with complete recanalization showed complete reperfusion (relative risk, 2.60; 95% CI, 1.63-4.13). Approximately one-third of patients showed some discrepancy between recanalization and reperfusion status. Lower NIHSS score (OR, 1.06; 95% CI, 1.01-1.11), smaller infarct core size (OR, 3.11; 95% CI, 1.46-6.66; and OR, 2.40; 95% CI, 1.14-5.02), smaller total ischemic area (OR, 4.20; 95% CI, 1.91-9.22; and OR, 2.35; 95% CI, 1.12-4.91), lower clot burden (OR, 1.35; 95% CI, 1.14-1.58), distal thrombus location (OR, 3.02; 95% CI, 1.76-5.20), and good collateral score (OR, 2.84; 95% CI, 1.34-6.02) significantly increased the odds of complete reperfusion. In multivariate analysis, only total ischemic area (OR, 6.12; 95% CI, 2.69-13.93; and OR, 1.91; 95% CI, 0.91-4.02) was an independent predictor of complete reperfusion. Recanalization and reperfusion are strongly associated but not always equivalent in ischemic stroke. A smaller total ischemic area is the only independent predictor of complete reperfusion.
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A4283