Initial angiographic appearance of intracranial vascular occlusions in acute stroke as a predictor of outcome of thrombolysis: Initial experience

J. J. Pillai, C. F. Lanzieri, S. B. Trinidad, R. W. Tarr, J. L. Sunshine, J. S. Lewin

Research output: Contribution to journalArticle

Abstract

PURPOSE: To determine whether the initial angiographic morphology and location of intracranial arterial occlusions in acute stroke are reliable predictors of success of thrombolysis. MATERIALS AND METHODS: Thirty-three intracranial occlusions were studied in 32 patients who underwent intraarterial thrombolysis with urokinase within 6 hours from clinical onset of stroke symptoms. The initial angiographic appearance of each occlusion was categorized as cutoff, tapered, meniscus, tram-track, or tandem. Following thrombolysis, outcomes were classified as complete, partial, or no recanalization. RESULTS: Complete recanalization was accomplished in 17 of the 33 lesions, partial recanalization in nine, and no effect in seven. Tram-track (n = 3) and tapered (n = 7) lesions demonstrated the highest rates of at least partial recanalization (100% and 86%, respectively), whereas cutoff lesions (n = 13) demonstrated the lowest rate (69%). Intracranial hemorrhage was associated with higher doses of urokinase. Complete recanalization success rates were 60% for M1 lesions (n = 10), 43% for M2 or A2 lesions (n = 14), and 33% for M3 lesions (n = 3). Vertebrobasilar lesion (n = 5) success rates for complete and at least partial recanalization were 80% and 100%, respectively. CONCLUSION: Relationships were found to exist between the success rate of recanalization and initial angiographic lesion location and morphology, which represent important trends; however, further studies with a larger sample size are needed.

Original languageEnglish (US)
Pages (from-to)733-738
Number of pages6
JournalRadiology
Volume218
Issue number3
DOIs
StatePublished - Jan 1 2001

Keywords

  • Brain, infarction
  • Cerebral blood vessels, stenosis or obstruction
  • Thrombolysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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