Abstract 2226: Predictors Of tPA Non-responders According To Location Of Vessel Occlusion

Abstract

Background and purpose: Information on the clinical and hemodynamic profile of IV tPA non-responders, at different location of arterial occlusion, may improve the selection of candidates for rescue reperfusion therapies. Therefore, we aimed to investigate predictors of failing IV tPA therapy according to occluded vessel and location of clot. Methods: We prospectively evaluated consecutive patients with an acute ischemic stroke admitted within the first 6 hours of onset. Five hundred and forty-eight patients with documented intracranial occlusion were included. Patients were categorized according to site of vessel occlusion into 4 distinct groups: proximal MCA occlusion (n=251), distal MCA occlusion (n=194), ICA T occlusion (n=61) and BA occlusion (n=42). Recanalization was assessed on TCD at 1 hour of tPA bolus. Results: Among patients with proximal MCA occlusion, the presence of severe extracranial ICA stenosis or occlusion (OR 2.36, 95% CI 1.15-4.84, p=0.02) and age >74 years (OR 1.84, 95% CI 1.02-3.31, p=0.04) independently predicted no recanalization (NR). No independent predictors of NR were identified in patients with distal MCA occlusion. In patients with ICA T occlusion, history of hypertension (OR 12.77, 95% CI 2.12-76.88, p=0.05) and absence of atrial fibrillation (OR 0.12, 95% CI 0.02-0.71, p=0.02) emerged as independent predictors of NR. Similarly, among patients with BA occlusion, atrial fibrillation was as an independent predictor of NR (OR 0.13, 95% CI 0.03-0.72, p=0.02). Conclusions: Absence of atrial fibrillation independently predicts persistent occlusion at 1-h after tPA bolus in patients with ICA T and BA occlusions. The use of relevant predictors of NR and a rapid neurovascular evaluation may improve the selection of patients for more aggressive rescue strategies.