Early stroke treatment with IV t-PA associated with early recanalization.
OBJECTIVE
Time from stroke onset to treatment (OTT) is potentially an important factor affecting subsequent outcome in patients treated with t-PA. The aim of the study was to assess the correlation between OTT and early recanalization rate after IV-t-PA therapy.


METHODS
Consecutive stroke patients treated with t-PA within 3h of onset were prospectively studied. Patients with major brain artery occlusion on MRA before t-PA infusion were enrolled. The correlation between OTT and the early recanalization rate within 1h after t-PA infusion was determined.


RESULTS
102 patients (M1 occlusion, 41 patients; M2, 19; ICA, 31; BA, 8; and PCA, 3) were enrolled. Follow-up MRA within 1h after t-PA infusion showed early recanalization in 42 (41.2%) patients (complete in 13 patients, partial in 29). The early recanalization rate was 53.8% with OTT <or=100 min, 57.1% in 101-110 min, 50.0% in 111-120 min, 63.6% in 121-130 min, 33.3% in 131-140 min, 30.0% in 141-150 min, 36.4% in 151-160 min, 18.2% in 161-170 min, and 32.0% in 171-180 min. OTT was negatively correlated with the early recanalization rate (r=-0.767, P=0.0301). After adjusting the presence of age (>74), ICA occlusion, baseline NIHSS score (<10), and glucose (>150 mg/dl), adjusted OR for early recanalization of OTT <or=130 min against OTT >130-180 min was 2.97 (95% CI 1.27-6.96, P=0.012).


CONCLUSIONS
Early recanalization depended on time from stroke onset to IV-t-PA administration. Thus, t-PA should be given to acute stroke patients as soon as possible.
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
Shibazaki
Kensaku
K
Aoki
Junya
J
Watanabe
Masao
M
Matsumoto
Noriko
N
Yamashita
Shinji
S
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007275:Injections, Intravenous / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator