title: Failure of complete recanalization is associated with poor outcome after cardioembolic stroke.
abstract: BACKGROUND
  Recanalization is strongly associated with outcomes after thrombolytic treatment. Cardiac emboli are known as better response to fibrinolytic agents because they are fibrin-rich; however, cardioembolic stroke itself is associated with poor outcomes and high mortality. Completeness of recanalization may therefore affect the outcome of cardioembolic stroke. We investigated whether degree of recanalization influences outcomes following fibrinolytic therapy in cardioembolic stroke.
  
  
  METHODS
  Consecutive stroke patients with relevant artery occlusions on baseline CT angiography who had received thrombolytic treatment were enrolled. Completeness of recanalization was assessed by the Thrombolysis in Myocardial Infarction (TIMI) grade, which was compared between patients with and without cardiac sources of embolism (CSE). We also investigated independent predictors of poor outcome (modified Rankin scale score 3-6) at 3 months.
  
  
  RESULTS
  Of the 127 patients enrolled, 65 (51%) had one or more CSE. Although the overall recanalization rates (TIMI 2 or 3) in patients with CSE (65%) and patients without CSE (68%) were similar (P=0.710), patients with CSE were less likely to show complete recanalization (TIMI 3) compared with those without CSE (19% vs. 39%, P=0.011). Multivariate analysis revealed that CSE was associated with failure of complete recanalization (OR 2.809, 95% CI 1.097-7.192) and was an independent predictor of poor outcome at 3months (OR 3.629, 95% CI 1.205-8.869).
  
  
  CONCLUSIONS
  In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis.
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: H S
authors.initials: HS
authors.lastname: Nam
authors.forename: K-Y
authors.initials: KY
authors.lastname: Lee
authors.forename: Y D
authors.initials: YD
authors.lastname: Kim
authors.forename: H-Y
authors.initials: HY
authors.lastname: Choi
authors.forename: H-J
authors.initials: HJ
authors.lastname: Cho
authors.forename: M-J
authors.initials: MJ
authors.lastname: Cha
authors.forename: C M
authors.initials: CM
authors.lastname: Nam
authors.forename: J H
authors.initials: JH
authors.lastname: Heo
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D020766:Intracranial Embolism / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
chemical_list: D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator