Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Assessment of Recanalization after Intra-Arterial Thrombolysis in Patients with Acute Ischemic Stroke : Proposed Modification of the Qureshi Grading System

  • Kim, Jae-Hoon (Department of Neurosurgery, Eulji University Eulji Hospital) ;
  • Kang, Hee-In (Department of Neurosurgery, Eulji University Eulji Hospital) ;
  • Moon, Byung-Gwan (Department of Neurosurgery, Eulji University Eulji Hospital) ;
  • Lee, Seung-Jin (Department of Neurosurgery, Eulji University Eulji Hospital) ;
  • Kim, Joo-Seung (Department of Neurosurgery, Eulji University Eulji Hospital)
  • Received : 2011.08.12
  • Accepted : 2012.05.17
  • Published : 2012.05.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : We aimed to investigate the correlation between the success of recanalization and a modified version of the Qureshi grading system in acute ischemic stroke patients. Methods : We retrospectively analyzed the intra-arterial thrombolysis (IAT) records of 37 patients who were evaluated by Thrombolysis in Myocardial Infarction (TIMI) and a modified version of the Qureshi grading systems as follows : 1) post-IAT Qureshi grade, 2) modified ${\Delta}$ Qureshi grade : pre-IAT group grade - post-IAT group grade (grade 1 : Qureshi grades 0-2 and grade 2 : Qureshi grade 3-5) and 3) ${\Delta}$ Qureshi grade (post-IAT Qureshi grade - pre-IAT Qureshi grade). Successful recanalization was defined as follows : 1) post-IAT TIMI grades 2 and 3, 2) post-IAT Qureshi grade 0-2, 3) modified ${\Delta}$ Qureshi grade=1, and 4) ${\Delta}$ Qureshi grade of ${\geq}2$ and/or post-IAT Qureshi grade=0. We investigated the correlation between the post-IAT TIMI grade and the modified Qureshi grade and also compared the various grading systems with modified Rankin Scale scores for evaluating the clinical outcome at 3 months. Results : The post-IAT Qureshi grade and ${\Delta}$ Qureshi grade and/or post-IAT Qureshi grade were significantly correlated with the TIMI grade (${\gamma}$=0.976 and, 0.942, respectively). Further, post-IAT Qureshi grade and ${\Delta}$ Qureshi grade and/or post-IAT Qureshi grade showed a significantly stronger association with clinical outcome than did the post-IAT TIMI grade (p=0.001 and, 0.000 vs. 0.083, respectively). Conclusion : Our preliminary results suggest that the modified Qureshi grading system is a useful tool for assessing the success of recanalization after IAT.

Keywords

References

  1. Christoforidis GA, Mohammad Y, Kehagias D, Avutu B, Slivka AP : Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke. AJNR Am J Neuroradiol 26 : 1789-1797, 2005
  2. Furlan AJ, Eyding D, Albers GW, Al-Rawi Y, Lees KR, Rowley HA, et al. : Dose Escalation of Desmoteplase for Acute Ischemic Stroke (DEDAS) : evidence of safety and efficacy 3 to 9 hours after stroke onset. Stroke 37 : 1227-1231, 2006 https://doi.org/10.1161/01.STR.0000217403.66996.6d
  3. Gonner F, Remonda L, Mattle H, Sturzenegger M, Ozdoba C, Lovblad KO, et al. : Local intra-arterial thrombolysis in acute ischemic stroke. Stroke 29 : 1894-1900, 1998 https://doi.org/10.1161/01.STR.29.9.1894
  4. Hacke W, Albers G, Al-Rawi Y, Bogousslavsky J, Davalos A, Eliasziw M, et al. : The Desmoteplase in Acute Ischemic Stroke Trial (DIAS) : a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke 36 : 66-73, 2005 https://doi.org/10.1161/01.STR.0000149938.08731.2c
  5. Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, et al. : Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 34 : e109-e137, 2003 https://doi.org/10.1161/01.STR.0000082721.62796.09
  6. Mohammad Y, Xavier AR, Christoforidis G, Bourekas E, Slivka A : Qureshi grading scheme for angiographic occlusions strongly correlates with the initial severity and in-hospital outcome of acute ischemic stroke. J Neuroimaging 14 : 235-241, 2004 https://doi.org/10.1111/j.1552-6569.2004.tb00244.x
  7. Mohammad YM, Christoforidis GA, Bourekas EC, Slivka AP : Qureshi grading scheme predicts subsequent volume of brain infarction following intra-arterial thrombolysis in patients with acute anterior circulation ischemic stroke. J Neuroimaging 18 : 262-267, 2008 https://doi.org/10.1111/j.1552-6569.2007.00233.x
  8. Mori E, Yoneda Y, Tabuchi M, Yoshida T, Ohkawa S, Ohsumi Y, et al. : Intravenous recombinant tissue plasminogen activator in acute carotid artery territory stroke. Neurology 42 : 976-982, 1992 https://doi.org/10.1212/WNL.42.5.976
  9. Qureshi AI : New grading system for angiographic evaluation of arterial occlusions and recanalization response to intra-arterial thrombolysis in acute ischemic stroke. Neurosurgery 50 : 1405-1414; discussion 1414-1415 , 2002
  10. Qureshi AI, Ali Z, Suri MF, Kim SH, Shatla AA, Ringer AJ, et al. : Intra-arterial third-generation recombinant tissue plasminogen activator (reteplase) for acute ischemic stroke. Neurosurgery 49 : 41-48; discussion 48-50, 2001
  11. Ringelstein EB, Biniek R, Weiller C, Ammeling B, Nolte PN, Thron A : Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization. Neurology 42 : 289-298, 1992 https://doi.org/10.1212/WNL.42.2.289
  12. Suarez JI, Sunshine JL, Tarr R, Zaidat O, Selman WR, Kernich C, et al. : Predictors of clinical improvement, angiographic recanalization, and intracranial hemorrhage after intra-arterial thrombolysis for acute ischemic stroke. Stroke 30 : 2094-2100, 1999 https://doi.org/10.1161/01.STR.30.10.2094
  13. TIMI Study Group : The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med 312 : 932-936, 1985
  14. Tomsick T, Broderick J, Carrozella J, Khatri P, Hill M, Palesch Y, et al. : Revascularization results in the Interventional Management of Stroke II trial. AJNR Am J Neuroradiol 29 : 582-587, 2008 https://doi.org/10.3174/ajnr.A0843
  15. von Kummer R, Holle R, Rosin L, Forsting M, Hacke W : Does arterial recanalization improve outcome in carotid territory stroke? Stroke 26 : 581-587, 1995 https://doi.org/10.1161/01.STR.26.4.581
  16. Zangerle A, Kiechl S, Spiegel M, Furtner M, Knoflach M, Werner P, et al. : Recanalization after thrombolysis in stroke patients : predictors and prognostic implications. Neurology 68 : 39-44, 2007 https://doi.org/10.1212/01.wnl.0000250341.38014.d2

Cited by

  1. Cerebral collaterals in acute ischaemia: Implications for acute ischaemic stroke patients receiving reperfusion therapy vol.53, pp.4, 2021, https://doi.org/10.1111/ejn.14955