Background and Purpose: Early recanalization of occluded intracranial arteries predicts favorable outcome in acute ischemic stroke (AIS) patients treated with intravenous alteplase therapy within 4.5 hours from stroke onset. Prior studies have shown recanalization of large vessel occlusion (LVO) with alteplase ranging from 0% for internal carotid artery and 33% for distal blood vessels. We performed an analysis to examine the characteristics of stroke patients and the location of LVO that predicts early recanalization in patients treated with intravenous alteplase alone. Methods: This single-center, retrospective study solely included AIS patients with LVO who were transferred to our institution for mechanical thrombectomy evaluation after treated with alteplase at a primary stroke center between January 2019 and January 2021. Recanalization was identified by repeated computed tomographic angiography (CTA) or digital subtraction angiography (DSA) at our institution upon arrival. Results: One hundred and six patients were included in the analysis, 15 (14.1%) patients had partial or complete recanalization of LVO. Cardioembolic was the most common cause of ischemic stroke (46%), followed by large vessel atherosclerosis (33%) in this group. They were more likely to have a medical history of hypertension (73.3% vs. 59.3%), better baseline function as measured by pre-modified Rankin Score 0-2 (73.3% vs. 68.1%), and receive early treatment (105 minutes vs. 135 minutes), compared to their counterparts with no recanalization. Proximal and distal middle cerebral artery had the same rate of recanalization in this cohort. Conclusion: The highest incidence of early recanalization of occluded intracranial arteries was found in cardioembolic strokes with middle cerebral artery being the most common location of recanalization. Early recanalization with intravenous alteplase was also associated with improved functional recovery at discharge.

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