Article Figures & Data
Figures
- Fig 1.
Recanalization of MCA occlusion without a good clinical outcome. A 67-year-old male patient presented 141 minutes after stroke onset. NIHSS score at presentation was 13, reducing to 10 following 99 mg of IV-rtPA. A, Baseline NCCT demonstrates a hyperattenuated left M1 MCA, ASPECTS of 6 (not shown), and CMR score = 2. B, CTA confirmed an MCA occlusion. C, Follow-up CTA demonstrates recanalization, and (D) an infarct within the left basal ganglia and frontal operculum on DWI. The 90-day mRS was 4.
Tables
ASPECTS (median [IQR]) 7.0 (3.0) Admission NIHSS score (median [IQR]) 15.0 (11.0) Time to presentation (min) 116.1 (89.1) Time to IV-rtPA (min) 153.2 (49.6) Total IV-rtPA dose (mg) 60.4 (18.7) Note:—Values are mean (standard deviation) unless otherwise specified.
- Table 2:
Univariate analysis in patients with and without recanalization, good outcome, or CMR
CT Angiographic Recanalization Good Outcome Clinically Meaningful Recanalization Yes (n = 73) No (n = 53) Yes (n = 45) No (n = 81) Yes (n = 36) No (n = 90) Age (yr) (mean) (SD) 74.4 (11.9) 70.6 (12.1) 70.0 (13.3) 74.4 (11.2) 70.5 (13.7) 73.7 (11.4) ASPECTS 8.0 (6.0–9.0) 6.0 (5.0–9.0) 8.0 (6.0–9.0) 7.0 (5.0–9.0)a 8.0 (6.25–9.0) 7.0 (5.0–9.0)a Hypertension (frequency) (%) 45 (61.6%) 37 (69.8%) 24 (53.3%) 58 (71.6%)a 20 (55.6%) 62 (68.9%) Diabetes (frequency) (%) 11 (15.1%) 11 (20.8%) 5 (10.9%) 17 (21.3%) 5 (13.9%) 17 (18.9%) Hypercholesterolemia (frequency) (%) 26 (35.6%) 17 (32.1%) 14 (30.4%) 29 (36.3%) 13 (36.1%) 30 (33.3%) Coronary artery disease (frequency) (%) 20 (27.4%) 8 (15.1%) 11 (23.9%) 17 (21.3%) 10 (27.8%) 18 (20.0%) Atrial fibrillation (frequency) (%) 25 (34.2%) 15 (28.3%) 16 (34.8%) 24 (30.0%) 11 (30.6%) 29 (32.2%) Smoking (frequency) (%) 10 (13.7%) 13 (24.5%) 11 (23.9%) 12 (15.0%) 8 (22.2%) 15 (16.7%) NIHSS score 14.0 (9.0–19.5) 17.0 (10.0–20.0) 10.0 (5.0–17.0) 18.0 (12.5–21.0)a 9.5 (5.25–18.0) 17.0 (11.75–21.0)a Blood glucose (mg/dL) (mean) (SD) 7.5 (5.9) 7.8 (2.5) 6.5 (1.3) 8.3 (5.8)a 6.4 (1.3) 8.2 (5.5) SBP (mm Hg) (mean) (SD)b 159 (25.8) 158 (25.8) 159.8 (29.7) 157.9 (25.9) 161.5 (30.6) 157.4 (25.9) Time to IV-rtPA (min) (mean) (SD) 157.1 (54.4) 147.9 (42) 150.4 (37.8) 154.8 (55.2) 152.4 (38.2) 153.6 (53.7) CBS 7.0 (6.0–9.0) 6.0 (3.0–8.5)a 8.0 (6.0–9.0) 6.0 (4.0–8.5)a 7.0 (6.0–9.0) 6.0 (4.0–9.0) Collateral score 2.0 (2.0–3.0) 2.0 (1.0–3.0) 2.0 (2.0–3.0) 2.0 (1.0–3.0) 2.0 (2.0–3.0) 2.0 (1.0–3.0) HT (frequency) (%) 73 (58) 53 (42) 17 (38) 28 (62) 13 (36) 46 (51) Note:—Unless otherwise noted, data are median (IQR). P values were obtained with ANOVA univariate analysis with post-hoc Bonferroni correction or with Kruskal-Wallis nonparametric analysis. HT indicates hemorrhagic transformation; SBP, systolic blood pressure.
↵a P < 0.05 was considered to indicate a significant difference.
↵b n = 125 for SBP due to missing data for 1 subject.
Clot Location CT Angiographic Recanalization Good Outcome Clinically Meaningful Recanalization Yes (n = 73) No (n = 53) Yes (n = 45) No (n = 81) Yes (n = 36) No (n = 90) ICA 8 (11.0)a 23 (43.4) 7 (15.6) 24 (29.6) 3 (8.3)a 28 (31.1) Proximal M1 10 (13.7)a 7 (13.2) 4 (8.9)a 13 (16.0) 4 (11.1)a 13 (14.4) Distal M1 27 (37.0) 10 (18.9) 13 (28.9) 24 (29.6) 14 (38.9) 23 (25.6) M2–M4 28 (38.4) 13 (24.5) 21 (46.7)a 20 (24.7) 15 (41.7) 26 (28.9) Note:—Location represents the most proximal site of occlusion. Data are frequency (%). P values were obtained with Kruskal-Wallis nonparametric analysis, followed by Mann-Whitney U post hoc tests.
↵a P < .05 was considered to indicate a significant difference.
- Table 4:
Number and percentage of patients achieving a clinically meaningful recanalization stratified against the CMR score
CMR Score Frequency of CMR (%) 0 9/13 (69%) 1 12/34 (35%) 2 11/35 (31%) 3 4/31 (13%) 4 0/13 (0%) Note:—CMR score is the sum of the stratified NIHSS score and the occlusion location score. For NIHSS, 0 = NIHSS 0–7; 1 = NIHSS 8–14; 2 = NIHSS 15–20; 3 = NIHSS >20. For occlusions, ICA and proximal M1 = 1; distal M1 and M2–M4 segments = 0. Scores range from 0–4. A higher CMR corresponded to a lower frequency of successful recanalization with IV-rtPA.
AIC R2 χ2(df) P Value Null model 150.2 Fitted model with admission NIHSS 136.4 10.7% 15.8 <.0001 Fitted model with occlusion location 144.7 5.1% 7.5 .0062 Fitted model with both NIHSS and occlusion location (CMR) 132.12 13.5% 20.1 <.0001 Note:—Performance of combining stratified NIHSS score and vessel occlusion location (CMR score) versus each alone. The null model was compared with a model fitted with admission NIHSS score, occlusion location, and the CMR score. To quantify the predictive effects of each parameter on CMR, the AIC and coefficient of determination R2 were calculated. A better model is evidenced by a lower AIC and a higher R2.
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