Early recanalization rate of major occluded brain arteries after intravenous tissue plasminogen activator therapy using serial magnetic resonance angiography studies.
OBJECTIVE
The present study investigated early recanalization rate of major occluded arteries after tissue plasminogen activator (t-PA) infusion using serial magnetic resonance angiography (MRA) studies.


METHODS
Consecutive stroke patients treated with t-PA within 3 h of onset were prospectively studied. Four serial MRA studies were conducted: before, immediately, 24 h and 5-7 days after t-PA infusion.


RESULTS
Initial MRA demonstrated occluded brain arteries in 64 patients: M1 occlusion, 30 patients; M2, 12, and internal carotid artery (ICA), 22. Combining M1 and M2 occlusion, the recanalization rates (complete and partial) were 52.3% (19.0 and 33.3%) within 1 h, 80.9% (47.6 and 33.3%) at 24 h and 87.8% (73.2 and 14.6%) 7 days after t-PA infusion. However, the recanalization rate of ICA occlusion was 31.8% (4.5 and 27.3%) within 1 h, 51.1% (14.3 and 47.6%) at 24 h and 66.7% (38.9 and 27.8%) 7 days after t-PA infusion. Complete recanalization rate at 24 h and 7 days was lower in ICA occlusion than M1 and M2 occlusion (p = 0.014 and p = 0.016).


CONCLUSIONS
Within 1 h after t-PA infusion, approximately half the patients with major arteries occlusion had early recanalization. ICA occlusion is resistant to intravenous t-PA therapy compared with middle cerebral artery occlusion.
Kimura
Kazumi
K
Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan. kimurak@med.kawasaki-m.ac.jp
Iguchi
Yasuyuki
Y
Shibazaki
Kensaku
K
Aoki
Junya
J
Uemura
Junichi
J
D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000188:drug therapy* / Q000473:pathology; D002545:Brain Ischemia / Q000188:drug therapy* / Q000473:pathology; D002536:Cerebral Arteries / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D010959:Tissue Plasminogen Activator