Initial angiographic appearance of intracranial vascular occlusions in acute stroke as a predictor of outcome of thrombolysis: Initial experience

PURPOSE: To determine whether the initial angiographic morphology and locat ion of intracranial arterial occlusions in acute stroke are reliable predic tors 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 a ppearance of each occlusion was categorized as cutoff, tapered, meniscus, t ram-track, or tandem. Following thrombolysis, outcomes were classified as c omplete, 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 part ial recanalization (100% and 86%, respectively), whereas cutoff lesions (n = 13) demonstrated the lowest rate (69%). Intracranial hemorrhage was assoc iated 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 3 3% for M3 lesions (n = 3). Vertebrobasilar lesion (n = 5) success rates for complete and at least partial recanalization were 80% and 100%, respective ly. CONCLUSION: Relationships were found to exist between the success rate of r ecanalization and initial angiographic lesion location and morphology, whic h represent important trends; however, further studies with a larger sample size are needed.