KMID : 1142120210230020244
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Journal of Stroke 2021 Volume.23 No. 2 p.244 ~ p.252
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Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion
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Kim Young-Dae
Nam Hyo-Suk Yoo Joon-Sang Park Hyung-Jong Sohn Sung-Il Hong Jeong-Ho Kim Byung-Moon Kim Dong-Joon Bang Oh-Young Seo Woo-Keun Chung Jong-Won Lee Kyung-Yul Jung Yo-Han Lee Hye-Sun Ahn Seong-Hwan Shin Dong-Hoon Choi Hye-Yeon Cho Han-Jin Baek Jang-Hyun Kim Gyu-Sik Seo Kwon-Duk Kim Seo-Hyun Song Tae-Jin Kim Jin-Kwon Han Sang-Won Park Joong-Hyun Lee Sung-ik Heo Joon-Nyung Choi Jin-Kyo Heo Ji-Hoe
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Abstract
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Background and Purpose: We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion.
Methods: Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization.
Results: Early recanalization, assessed 61.0¡¾44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032).
Conclusions: The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.
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KEYWORD
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Ischemia, Stroke, Thrombosis, Thrombolysis, Reperfusion
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