A subgroup of 27 patients with MCA occlusion treated with intravenous thrombolysis was included in the analysis of recanalization

characteristics. Patients were excluded due to lack of evidence of ICA or MCA occlusion on CTA [17], absence of temporal windows [11], incomplete or poor quality CTA [4], PCA occlusion [1] or aplastic or hypoplastic ACA [3], and non-stroke [1]. Occlusion site was determined by CTA and included 42 M1/M2 occlusions and 11 intracranial ICA occlusions. Baseline characteristics of the main sample and MCA thrombolysis subgroup are shown in Table 1 and Table 2. Significant FD to the ACA was present in Selleck SP600125 24/53 (45%) patients and to the PCA in 8/38 (21%) patients. Because adequate insonation of both PCAs was not possible in 15/53 (28%) of patients, further analysis of PCA FD was not undertaken. The differences in admission and outcome variables between groups

defined by the presence or absence of FD are displayed in Table 3. The presence of ACA FD was strongly associated with a CTA good collateral flow grade; 18 of 23 (78%) with good CTA collaterals had an ACA ratio greater than 1.3. However, 23 of 26 (88%) VX-809 ic50 with reduced CTA collaterals had an ACA FD ratio less than 1.3 (Odds ratio 27.6, p < 0.001). Twenty-four hour core infarct expansion (Δ core >5 ml between baseline and 24 h imaging) was also strongly associated with ACA FD where only 6 of 22 patients (27%) with an ACA FD ratio of greater than 1.3 had infarct core growth compared with 22 of 28 (78%) with ACA FD ratios of less than Bcl-w 1.3 (Odds ratio 9.7, p < 0.001). The presence of ACA FD may indicate a subgroup of patients with better collateral flow and a relatively stable ischemic penumbra. After adjusting for occlusion site, stroke onset time to CT, age and gender, the two predictors of baseline infarct core volume on linear regression analysis were FD (p < 0.001) and acute NIHSS (p = 0.002). Predictors of penumbral volume, after adjusting for occlusion site, acute NIHSS, onset time to CT and gender, FD (p < 0.001) and younger age (p = 0.016) (r2 = 0.3707) remained

significant. Predictors of 24 h infarct volume after adjusting for occlusion site, therapy with thrombolytic agent, and stroke onset to thrombolytic treatment time were: FD (p < 0.001), major reperfusion (p < 0.001) and lower acute NIHSS (p = 0.02) (r2 = 0.6689). Independent predictors of a favourable clinical outcome, as measured by 90 day mRS 0–2, were FD (OR 27.5, p < 0.001), major reperfusion (OR 21.1, p = 0.005; Table 4). All patients with ICAO as the site of vessel occlusion had a poor outcome. The characteristics of the patients with MCA occlusion treated with intravenous thrombolysis are shown in Table 2. Patients with major reperfusion post-thrombolysis were significantly older than those with non-reperfusion (71 years vs 56 years, p = 0.