Clinical and Radiological Predictors of Recanalization after IV rt-PA in Patients of Acute Ischemic Stroke

Abstract

AbstractBackground and Aim: Acute Ischemic Stroke (AIS) is defined as a focal neurological deficit lasting for more than 24 hours with no cause other than that of vascular origin. Stroke is the third commonest cause of mortality after cardiac disease, cancer and the first cause of disability. Current treatment for AIS includes thrombolytic drugs such as rt-PA which dissolve occlusive blood clots and reversing the ischemia in salvageable area of the penumbra adjacent to irreversible infracted area. The purpose of this study is to assess the predictors of recanalization after treatment via rt-PA.Aim of Study: Was to assess the clinical and radiological predictors of the recanalization after IV thrombolytic therapy in patients of AIS.Subjects and Methods: This study was conducted in the Departments of Neuropsychiatric and Radiology, Tanta Uni-versity on 25 patients of AIS in the period between August 2016 and February 2017. They were classified into 2 groups according to the successful recanalization or not. All patients were subjected to full history taking, neurologic examination including evaluation by National Institute of Health Stroke Scale (NIHSS), laboratory investigations, neuroimaging including: Computed Tomography (CT), Transcranial Doppler Ultrasound (TCD) and CT angiography which were done with follow-up 24 hours later.Results: The mean age of the group of successful recanal-ization was 62.12±13 while in the group of failed recanalization was 69.21±10. Smoking and DM were significantly higher among patients with failed recanalization while cardiac prob-lems were significantly more common in patients with suc-cessful recanalization. In addition, the recanalization was associated with significant improvement in stroke severity. Distal MCA occlusion had a better chance of recanalization via rt-PA than proximal MCA occlusion.TCD had 81.25% sensitivity and 100% specificity compared to CTA.Conclusion: IV rt-PA is an effective treatment of AIS. Earlier rt-PA timing of administration and lower NIHSS were significant predictors for successful recanalization. TCD is an easy, fast and feasible tool to assess the occluded vessels with near results to CTA.