Selection Criteria in Endovascular Thrombectomy and Thrombolytic Therapy (SECRET) Study: Development of Patient Selection Criteria Using CT Images and Accompanying Diseases for Efficient Intravenous Thrombolytic and Intra-arterial Recanalization Therapy in Acute Ischemic Stroke

Study Overview
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Brief Summary
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Use of intravenous (IV) thrombolysis and intra-arterial (IA) recanalization treatment has been rapidly increasing, However, despite of the treatment, recanalization rates are 22.6 - 70% and only 30-50% of patients show meaningful clinical improvements. Mechanisms of futile recanalization may include 1) large ischemic core, 2) poor collateral, and 3) presence of comorbidity. In this regards, developing selection criteria using acute stroke imaging and comorbidity is warranted. Investigators will recruit the consecutive acute stroke patients who received IV thrombolysis and/or IA recanalization treatment. This study will perform with prospective design to develop CT-based clot, core and collateral scores and a comorbidity index for selecting stroke patients who are at high risks by the treatment. Investigators will firstly establish the CT-based scores and comorbidity index using a pre-existing cohort database. Using these CT-based and comorbidity index, Investigators will validate them in a multi-center prospectively cohort. In addition, Investigators will assess the cost-effectiveness of selecting patients based on the comorbidity index.

Conditions
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Ischemic Stroke

Intervention / Treatment
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* Other: Brain CT imaging


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥20 years old Acute ischemic stroke patients who underwent CT angiographies before IV thrombolysis and/or IA recanalization treatment Patients who give an informed consents for participation in the study or the legal representative or immediate family give informed consent on behalf of patients in case of difficulty to decide study enrollment. Exclusion Criteria: Age <20 years old Acute ischemic stroke patients who did not receive IV thrombolysis and/or IA recanalization treatment No informed consents from patients

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Acute ischemic stroke patients<br>Acute ischemic stroke patients who received intravenous (IV) thrombolysis and/or intra-arterial (IA) recanalization treatment | Other: Brain CT imaging<br>* Investigators will analyzed the CT image that was performed in patients with hyperacute stroke. The CT protocol includes CT thrombus, collateral, core images. Investigators also obtain detailed history and laboratory and imaging result for comorbidity. The comorbidity index protocol is based on the Charlson comorbidity index.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified Rankin scale scores |  | 3 months after discharge day | 
| Death |  | 6 months after discharge day | 
| National Institutes of Health Stroke Scale (NIHSS) scores |  | 1 hr after IV rt-PA infusion | 
| Recanalization rate |  | after 16 hrs thrombolytic treatments in MRA, CTA, or digital subtraction angiography (DSA) | 
| Recanalization rate |  | after 24 hrs thrombolytic treatments in MRA, CTA, or digital subtraction angiography (DSA) | 
| Recanalization rate |  | after 32 hrs thrombolytic treatments in MRA, CTA, or digital subtraction angiography (DSA) | 
| Symptomatic hemorrhagic transformation rate |  | after 16 hrs thrombolytic treatments in MR or CT | 
| Symptomatic hemorrhagic transformation rate |  | after 24 hrs thrombolytic treatments in MR or CT | 
| Symptomatic hemorrhagic transformation rate |  | after 32 hrs thrombolytic treatments in MR or CT | 
| asymptomatic hemorrhagic transformation rate |  | after 16 hrs thrombolysis in MR or CT | 
| asymptomatic hemorrhagic transformation rate |  | after 24 hrs thrombolysis in MR or CT | 
| asymptomatic hemorrhagic transformation rate |  | after 32 hrs thrombolysis in MR or CT |