Longer time to assessment of recanalization, increased permeability of the thrombus, and more distal thrombus location are linked with arterial occlusion recanalization following intravenous alteplase in individuals with severe ischemic stroke, according to a study recently published in JAMA.
Participants in this study came from 12 centers located in Canada, South Korea, Turkey, Czech Republic, and Spain. Data on clinical features, time between alteplase and recanalization, demographics, and location and permeability of the intracranial thrombus were recorded on computed tomographic angiography. The primary measure was recanalization on computed tomographic angiography of region of interest within 6 hours of baseline computed tomographic angiography.
This multicenter, prospective cohort study included 575 individuals with intracranial arterial occlusion and acute ischemic stroke, 275 of whom received only intravenous alteplase, 195 of whom received alteplase and endovascular thrombectomy, 48 of whom received only endovascular thrombectomy, and 57 of whom were treated conservatively. Recanalization assessment took place a median of 158 minutes (IQR, 79 to 268) after baseline computed tomographic angiography and 132.5 minutes (IQR, 62 to 238) after initiation of intravenous alteplase. Alteplase was associated with 30.4% success in recanalization, while only 13.3% who did not receive alteplase had success (difference, 17.1%; 95% CI, 10.2%-25.8%). Successful recanalization among those receiving alteplase was associated with longer time to assessment of recanalization (odds ratio [OR] 1.28 per 0.5-hour increase in time; 95% CI, 1.18-1.38), higher thrombus permeability (OR 7.03; 95% CI, 3.32-14.87), and more distal thrombus location (OR 5.61; 95% CI, 2.38-13.26).
The study researchers concluded that, “These findings may help inform treatment and triage decisions in patients with acute ischemic stroke.”
Menon BK, Al-Ajlan FS, Najm M, et al. Association of clinical, imaging, and thrombus characteristics with recanalization of visible intracranial occlusion in patients with acute ischemic stroke. JAMA. 2018;320(10):1017-1026.