title: Conservative medical treatment and intravenous thrombolysis in acute stroke from carotid T occlusion.
abstract: BACKGROUND
  We aimed to analyse the course of early recanalization and corresponding functional outcome in patients with an acute occlusion of the carotid T who were treated conservatively or underwent intravenous thrombolysis.
  
  
  METHODS
  Forty-two patients with an acute occlusion of the carotid T within 6 h were recruited from consecutive admissions to a neurological department participating in the Duplex Sonography in Acute Stroke study. All patients underwent a standardized admission and follow-up procedure. Colour-coded duplex sonography was performed on admission, 30 min after thrombolysis, and at 6 and 24 h after onset of symptoms. Recanalization of the carotid T was classified as complete, partial and absent. Functional outcome was rated with the modified Rankin scale (mRS) at 3 months as favourable (mRS 0-2) or poor (mRS 3-6).
  
  
  RESULTS
  Within 6 h, complete or partial recanalization occurred in 1 of 27 patients treated conservatively and in 6 of 15 thrombolysed patients. Intravenous thrombolysis predicted early recanalization also after adjustment for age, sex, cardioembolic stroke aetiology and time to treatment (adjusted odds ratio, OR, 39.7; 95% confidence interval, CI, 2.0-801.7; p = 0.016). An early recanalization was the only selected predictor of a favourable outcome (OR, 13.6; 95% CI, 1.0-179.0; p = 0.047) at regression analysis, and was achieved in 3 thrombolysed patients but in none with conservative medical treatment.
  
  
  CONCLUSIONS
  In patients treated conservatively, functional outcome is poor and early recanalization rarely occurs. The latter can be achieved by intravenous thrombolysis with a rate comparable to that found at an intra-arterial approach without major intracranial bleeding complications. Early recanalization is associated with a better functional outcome.
authors.affiliation: Department of Neurology, Otto von Guericke University Magdeburg, Germany. michael.wunderlich@medizin.uni-magdeburg.de
authors.forename: Michael T
authors.initials: MT
authors.lastname: Wunderlich
authors.forename: Erwin
authors.initials: E
authors.lastname: Stolz
authors.forename: Gunter
authors.initials: G
authors.lastname: Seidel
authors.forename: Thomas
authors.initials: T
authors.lastname: Postert
authors.forename: Georg
authors.initials: G
authors.lastname: Gahn
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sliwka
authors.forename: Michael
authors.initials: M
authors.lastname: Goertler
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002341:Carotid Artery Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial