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Initial Angiographic Appearance of Intracranial Vascular Occlusions in Acute Stroke as a Predictor of Outcome of Thrombolysis: Initial Experience¹

¹ From the Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Ohio. From the 1999 RSNA scientific assembly. Received December 9, 1999; revision requested January 18, 2000; revision received July 10; accepted July 25. Address correspondence to J.J.P., Department of Radiology, Division of Neuroradiology, Medical College of Georgia, 1120 15th St, Augusta, GA 30912 (e-mail: jpillai@mail.mcg.edu).

PURPOSE: To determine whether the initial angiographic morphology and location of intracranial arterial occlusions in acute stroke are reliable predictors of success of thrombolysis.

MATERIALS AND METHODS: Thirty-three intracranial occlusions were studied in 32 patients who underwent intraarterial thrombolysis with urokinase within 6 hours from clinical onset of stroke symptoms. The initial angiographic appearance of each occlusion was categorized as cutoff, tapered, meniscus, tram-track, or tandem. Following thrombolysis, outcomes were classified as complete, partial, or no recanalization.

RESULTS: Complete recanalization was accomplished in 17 of the 33 lesions, partial recanalization in nine, and no effect in seven. Tram-track (n = 3) and tapered (n = 7) lesions demonstrated the highest rates of at least partial recanalization (100% and 86%, respectively), whereas cutoff lesions (n = 13) demonstrated the lowest rate (69%). Intracranial hemorrhage was associated with higher doses of urokinase. Complete recanalization success rates were 60% for M1 lesions (n = 10), 43% for M2 or A2 lesions (n = 14), and 33% for M3 lesions (n = 3). Vertebrobasilar lesion (n = 5) success rates for complete and at least partial recanalization were 80% and 100%, respectively.

CONCLUSION: Relationships were found to exist between the success rate of recanalization and initial angiographic lesion location and morphology, which represent important trends; however, further studies with a larger sample size are needed.

Index terms: Brain, infarction, 173.781, 174.781, 175.781 • Cerebral blood vessels, stenosis or obstruction, 173.7214, 174.7214, 175.7214 • Thrombolysis, 173.1265, 174.1265, 175.1265

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