[Prognostic impact of time-point and degree of arterial recanalization of acute middle cerebral artery occlusions after intravenous tPA administration].
OBJECTIVE
We aimed to evaluate the prognostic impact of the degree and time-point of arterial recanalization during the first 24h after tPA administration in patients with acute middle cerebral artery (MCA) occlusions.


METHODS
We prospectively studied consecutive ischemic stroke patients treated with i.v. tPA following SITS-MOST criteria, who showed MCA occlusions on pre-bolus transcranial Duplex (TCCD) examinations. TCCD recordings were obtained 1, 2, 6, 12 and 24h after t-PA treatment. Thrombolysis in Brain Ischemia criteria were used to define complete, partial or absent MCA recanalization at each time point. Early neurological improvement (ENI) was defined as a decrease in 4 points in the NIHSS score during the first 24h. A modified Rankin scale score 2 at day 90 was considered indicative of good long-term clinical outcome.


RESULTS
A total of 61 patients were included. Median baseline NIHSS score was 13 (interquartile range 9-18). ENI was observed in 32 (53%) patients. Complete, but not partial, recanalization at any time-point was independently associated with ENI in adjusted logistic regression models. The probability of ENI was maximal for <1h complete recanalization (OR 14.7, 95% CI [1.9-109.2], P=.009) and gradually decreased with later time-points. Thirty-five (57%) patients showed good long-term outcome. Both partial and complete MCA recanalizations achieved at any time-point during the first 12h after tPA bolus were independently associated with a good outcome. Odds ratio for favourable outcome was maximal (OR 33.7, 95% CI [2.2-520]; P=.012) when recanalization was achieved during tPA infusion.


CONCLUSIONS
Any degree of MCA recanalization observed during the first 12h following tPA administration predicted good long-term outcomes. Only complete recanalization was associated with early neurological improvement.
Servicio de Neurología, Departamento de Neurociencias, Hospital Universitari Germans Trias i Pujol, Badalona, (Barcelona), España. lauritadb@yahoo.es
Laura
L
Dorado
Juan F
JF
Arenillas
Mònica
M
Millán
Natalia
N
Pérez De La Ossa
Cristina
C
Guerrero
Antoni
A
Dávalos
D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy*; D007262:Infusions, Intravenous; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014654:Vascular Patency
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator