Recanalization within one hour after intravenous tissue plasminogen activator is associated with favorable outcome in acute stroke patients.
OBJECTIVE
Early recanalization after tissue plasminogen activator (t-PA) infusion greatly improves outcome in stroke patients. However, the time threshold of early recanalization for a favorable outcome remains unclear. The aim of this study was to assess patient outcome 3 months after t-PA therapy among patients with early, delayed and without recanalization.


METHODS
Consecutive patients with major brain artery occlusion on magnetic resonance angiography (MRA) before t-PA infusion were enrolled. We divided the patients into 3 groups according to the findings of follow-up MRA 1 and 24 h after t-PA: the early group who had recanalization within 1 h after t-PA; the delayed group who had recanalization between 1 and 24 h, and the no recanalization group. We then assessed the outcomes (modified Rankin score 0-1) 3 months after t-PA therapy among the 3 groups.


RESULTS
A total of 92 patients (53 men, mean age 75.8 +/- 10.3 years) were enrolled. A favorable outcome was most frequently observed in the early group (n = 39, 40.6%), followed by the delayed group (n = 25, 18.2%), and the no recanalization group (n = 28, 10.5%; p = 0.037). After adjusting for age, atrial fibrillation and NIHSS score, the adjusted OR for early recanalization when compared with no recanalization was 7.11 (95% CI 1.177-43.063; p = 0.032) for a favorable outcome, while the adjusted OR for delayed recanalization was 1.75 (95% CI 0.104-29.356; p = 0.698).


CONCLUSIONS
Early recanalization within 1 h after intravenous t-PA is associated with a favorable outcome in stroke patients.
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan. kimurak@med.kawasaki-m.ac.jp
Kazumi
K
Kimura
Yasuyuki
Y
Iguchi
Kensaku
K
Shibazaki
Junya
J
Aoki
Masao
M
Watanabe
Kazuto
K
Kobayashi
Yuki
Y
Sakamoto
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D008297:Male; D020127:Recovery of Function / Q000187:drug effects; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator