Reperfusion Is a Stronger Predictor of Good Clinical Outcome than Recanalization in Ischemic Stroke

Abstract

Reperfusion showed stronger association with good clinical outcome than did recanalization.

Effect of Collaterals on Clinical Presentation, Baseline Imaging, Complications, and Outcome in Acute Stroke

“…Median (interquartile range) ASPECTS and baseline NIHSS score were 7 (6 -9) and 14 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) No significant group differences in rtPA use were present on the basis of baseline thresholded ischemic penumbra or core size, though patients receiving rtPA were treated earlier and tended toward higher baseline NIHSS, more proximal clot location, and smaller final infarct size than those receiving supportive medical care. The absence of collaterals was associated with larger total GM/WM ischemic volumes, including infarct core irrespective of recanalization status (On-line Table 1).…”

Predictors of Reperfusion in Patients with Acute Ischemic Stroke

“…tive factors and outcome (final infarct size and mRS at 3 months). 6,11,16 This is not surprising because reperfusion is a parameter situated between recanalization and outcome. Our data confirm that these relations are already established at day 3, relatively early in the clinical course.…”

“…The most frequently found imaging predictor of reperfusion was recanalization in both CT and MR imaging studies. 5,6,11,16,17,36 However, recanalization is not a variable that can be assessed before treatment. Good collateral scores, treatment with alteplase or tenecteplase, older age, and lesion geography and structure were also associated with better reperfusion.…”

“…[7][8][9][10] Other articles suggest that this assumption is not justified and found reperfusion to be a better predictor of follow-up infarct volume and clinical outcome than recanalization. 5,8,9,[11][12][13][14][15] Although recanalization correlates well with improved reperfusion rates, it is unclear which other clinical and imaging factors influence reperfusion. 5,6,11,12,16 Knowing which factors, available before treatment decisions, predict complete reperfusion could aid in decision-making.…”

“…5,8,9,[11][12][13][14][15] Although recanalization correlates well with improved reperfusion rates, it is unclear which other clinical and imaging factors influence reperfusion. 5,6,11,12,16 Knowing which factors, available before treatment decisions, predict complete reperfusion could aid in decision-making. Treatment with IV-rtPA, good collateral scores and lesion geography (location of the infarct relative to penumbra), and structure (solitary or multiple infarct areas) have been related to reperfusion status assessed with CT or MR imaging.…”