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Response to the comment on ‘Predictors for large vessel recanalization before stroke thrombectomy: the HALT score’
  1. Huanwen Chen1,2,
  2. Marco Colasurdo3,
  3. Chad Schrier2,
  4. Mazhar Khalid2,
  5. Mihir Khunte4,
  6. Timothy R Miller3,
  7. Jacob Cherian5,
  8. Ajay Malhotra6,
  9. Dheeraj Gandhi7
  1. 1 National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
  2. 2 Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
  3. 3 Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
  4. 4 Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
  5. 5 Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
  6. 6 Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
  7. 7 Departments of Radiology, Neurology, and Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA
  1. Correspondence to Dr Dheeraj Gandhi, Department of Radiology, Neurology, and Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, 21201, USA; dgandhi{at}

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We thank the authors of the comment on our recent publication in the Journal of NeuroInterventional Surgery,1 which described our single-center endeavor to identify predictors of large vessel recanalization (LVR) and our proposal of the HALT score. We appreciate the acknowledgment that the HALT score may serve as a helpful tool to optimize acute stroke triage and for decisions to administer thrombolytic agents. We also thank the editor for the opportunity to respond to concerns raised within the comment.

First, while our model suggested that patients with vertebrobasilar artery occlusions had a higher likelihood of recanalization compared with other sites of vascular occlusion, this population represented a small portion of our study cohort, and thus the results should not be over-interpreted. We carefully addressed this surprising finding in our discussion section and proposed likely explanations for this observation. The comment aptly pointed out the meta-analysis of LVR by Seners et al,2 which reported a lower rate of recanalization for patients with basilar occlusions. In their study, only 49 of 2063 patients with large vessel occlusio (LVO) identified in the literature had basilar occlusions, which was only marginally greater than the 35 of 640 patients in our study. Given the low numbers published in our study and the past literature, it is unclear if differences in LVR rates were due to chance or reflected true discrepancies. More importantly, we performed a sensitivity analysis of the HALT score excluding posterior circulation strokes, and the …

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  • Contributors HC wrote the manucript. MC, and DG critically revised the manuscript. All authors reviewed and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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