Angiographic demarcation of an occlusive lesion may predict recanalization after intra-arterial thrombolysis in patients with acute middle cerebral artery occlusion

BACKGROUND AND PURPOSE The aim of this study is to investigate whether angiographic demarcation of an occlusive lesion may predict successful or failed result of intra-arterial thrombolysis in acute middle cerebral artery (MCA) occlusion. METHODS We reviewed retrospectively the angiography and clinical data of acute MCA occlusion patients who underwent intra-arterial thrombolysis from 1994 to 2004. Pretreatment angiographic findings at the occlusive lesions were classified as either blurred or sharp, depending on whether the proximal portion of the occlusive lesions had poorly or well demarcated margins. Using uni- or multivariate analysis, recanalization was correlated with our angiographic classification or other clinical variables. RESULTS Forty-six patients with MCA occlusions underwent intra-arterial thrombolysis during the 10-year period. Forty-four of the angiograms could be classified into one of the two categories: Blurred-type in 20 patients and Sharp-type in 24 patients. Univariate analysis showed a significant association of the classification with recanalization. (Recanalization rate: 95% in Blurred-type and 38% in Sharp-type, P < .0001) Logistic regression analysis showed that the association was independent from other factors (P = .004). CONCLUSION In acute MCA occlusion, our classification may indicate the difficulty of the recanalization procedure, and may assist in patient triage for different intra-arterial treatment strategies.