Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
Young Dae Kim, Hyo Suk Nam, Joonsang Yoo, Hyungjong Park, Sung‐Il Sohn, Jeong‐Ho Hong, Byung Moon Kim, Dong Joon Kim, Oh Young Bang, Woo‐Keun Seo, Jong‐Won Chung, Kyung‐Yul Lee, Yo Han Jung, Hye Sun Lee, Seong Hwan Ahn, Dong Hoon Shin, Hye‐Yeon Choi, Han‐Jin Cho, Jang‐Hyun Baek, Gyu Sik Kim, Kwon–Duk Seo, Seo Hyun Kim, Tae‐Jin Song, Jinkwon Kim, Sang Won Han, Joong Hyun Park, Sung Ik Lee, JoonNyung Heo, Jin Kyo Choi, Ji Hoe Heo, on behalf of the Thrombus Imaging Study Group and the SECRET Study Group
Abstract
BACKGROUND AND PURPOSE: We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. METHODS: Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. RESULTS: Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). CONCLUSIONS: The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.