Spontaneous recanalization of major cerebral arterial occlusion just before emergent conventional angiography

초록

Background and Aims Mechanical thrombectomy is one of treatment options to the patients with hyperacute ischemic stroke caused by major cerebral artery occlusion. Sometimes, spontaneous recanalization was observed on emergent conventional angiography. However, characteristics of recanalization in hyperacute period remained unknown. Here, we investigated the predictors for recanalization of major cerebral arterial occlusion just before conventional angiography and outcomes of these cases. Method We reviewed hyperacute ischemic stroke patients who were admitted from July 2013 to August 2015 and took conventional angiography after identification of major arterial occlusion on MR or CT scans. We analyzed the difference of risk factors, clinical characteristics and outcomes between the spontaneous recanalization group and the others. Results A total of 104 subjects were enrolled (70 men, 69.0±10.6 years old). Among them, nine patients had recanalization on conventional angiography before neurointervention(9 men, 66.0±10.2 years old). Spontaneous recanalization group was more frequently associated with men (p=0.02), embolic stroke etiology (p=0.05) and the history of diabetes mellitus(p 0.02), compared to non-recanalization group. Duration from stroke onset to MR or CT scan was much shorter in recanalization group than non-recanalization group(63.1±21.2 vs 180.4±276.2 minutes, p<0.01). Among recanalization group, four subjects (44.4%) had 2 or less modified Rankin Score on 3 months after stroke onset and none had early neurologic deficit or re-occlusion. Conclusion Our result suggests spontaneous recanalization might occur within a few hours after stroke onset. This recanalization was associated with men, diabetes mellitus and embolic stroke. Re-occlusion or early neurologic deficit seems to be infrequent in case of the spontaneous recanalization.