Atrial fibrillation as an independent predictor for no early recanalization after IV-t-PA in acute ischemic stroke.
OBJECTIVE
Intravenous administration of tissue plasminogen activator (t-PA) dissolves the clot and can improve clinical outcome in patients with acute ischemic stroke. However, lack of early recanalization frequently does not result in good outcome.


METHODS
We prospectively studied acute stroke patients treated with t-PA and examined clinical factors associated with no early recanalization of occluded arteries after t-PA administration using serial magnetic resonance angiography (MRA). NIHSS score was obtained before and at 24h after t-PA administration.


RESULTS
Subjects comprised 49 consecutive stroke patients treated with t-PA. Initial MRA before t-PA infusion demonstrated occluded arteries in 37 patients. Of the 37 occluded arteries, follow-up MRA within 30min after t-PA administration revealed complete recanalization in 6 patients, partial recanalization in 12, and no early recanalization in 19. Neurological worsening (total NIHSS score increased by > or =4) occurred in 0 of 18 patients with recanalization and 4 of 19 patients with no recanalization (P=0.039). Atrial fibrillation (AF) and hypertension were more frequent in patients with non-early recanalization than in patients with recanalization (73.7% vs. 38.9%, P=0.03; 73.6% vs. 38.9%, P=0.03, respectively). However, no differences were observed in other clinical factors between groups. Multivariate logistic regression analysis demonstrated AF (OR: 9.3; CI: 1.5-55.8, P=0.015) as the only independent factor associated with no recanalization.


CONCLUSIONS
No early recanalization after t-PA administration was observed in 51.4% of acute stroke patients with occluded arteries and was significantly associated with neurological worsening. AF was independently associated with no recanalization after t-PA administration.
Kimura
Kazumi
K
Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan. kimurak@med.kawasaki-m.ac.jp
Iguchi
Yasuyuki
Y
Yamashita
Shinji
S
Shibazaki
Kensaku
K
Kobayashi
Kazuto
K
Inoue
Takeshi
T
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002536:Cerebral Arteries / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator