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


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.



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