Qureshi Grading Scheme Predicts Subsequent Volume of Brain Infarction Following Intra-Arterial Thrombolysis in Patients with Acute Anterior Circulation Ischemic Stroke

ABSTRACT BACKGROUND The importance of the site of occlusion and the presence or absence of collaterals on initial angiography in patients with acute ischemic stroke has been recognized. Qureshi recently proposed a scheme that categorizes patients with ischemic stroke based on findings observed on initial angiography. METHODS We determined the relationship between severity of angiographic occlusion using Qureshi grading scheme and volume of brain infarction on follow‐up computed tomography in 55 patients with anterior circulation ischemic stroke who underwent intra‐arterial thrombolysis. RESULTS A strong association was observed between Qureshi grades and volume of brain infarction (F ratio 6.2, P= .0005) after adjusting for patients' age, sex, National Institutes of Health Stroke Scale (NIHSS) score, thrombolytic used, and time interval between symptom onset and angiography. The relationship persisted after further adjustment for final angiographic recanalization (F ratio 5.1, P= .001). A significant relationship between initial grades and volume of brain infarction was separately observed in both patients with or without recanalization following treatment. CONCLUSIONS Qureshi grading scheme can be effectively used to stratify patients with anterior circulation ischemic stroke undergoing intra‐arterial thrombolysis using initial angiographic findings.