DOES ARTERIAL RECANALIZATION IMPROVE OUTCOME IN CAROTID TERRITORY STROKE

Background and Purpose We sought to determine whether early (<8 hours) or delayed (8 to 24 hours) recanalization after stroke may be an inde pendent variable in the improvement of clinical outcome in patients wi th occlusion of the middle cerebral artery. Methods We prospectively s tudied 77 patients by combined Scandinavian Stroke Scale score at admi ssion, repeated computed tomography and angiography before and after t hrombolytic treatment at <8 hours after stroke onset, and transcranial Doppler ultrasound 24 hours later. We tested an association between c linical and neuroradiological baseline characteristics, recanalization , and outcome as assessed by the modified Rankin Scale 4 weeks after s troke and determined the effect of recanalization on mortality and goo d outcome (Rankin Scale grades 0 to 3) by multiple logistic regression analyses. Results Recanalization rates at 8 and 24 hours after stroke correlated with sites of occlusion (middle cerebral artery branch, 73 % and 73%; trunk, 27% and 38%, respectively; intracranial internal car otid artery bifurcation, 14% and 14%; P=.002), collaterals (good, 43% and 51%, respectively; scarce, 17% and 19%, respectively; P=.01), and Scandinavian Stroke Scale score at admission (P=.002). Six of 7 patien ts with delayed recanalization had good outcomes. Recanalization at <8 hours after symptom onset had no independent predictive value for goo d outcome (P=.69). Recanalization at 24 hours increased the proportion of good outcomes from 23% to 75% in a subgroup of patients. Recanaliz ation did not independently affect mortality (P>.15). Conclusions Even if delayed, arterial recanalization may improve clinical outcome in a subgroup of patients with middle cerebral artery occlusion.