title: Predictors of tissue-type plasminogen activator nonresponders according to location of vessel occlusion.
abstract: OBJECTIVE
  Information on the clinical and hemodynamic profile of intravenous tissue-type plasminogen activator nonresponders, at different locations of arterial occlusion, may improve the selection of candidates for rescue reperfusion therapies. Therefore, we aim to investigate predictors of failing intravenous tissue-type plasminogen activator therapy according to occluded vessel and location of the clot.
  
  
  METHODS
  We prospectively evaluated consecutive patients with an acute ischemic stroke admitted within the first 6 hours of onset. Five hundred forty-eight patients with documented intracranial occlusion were included. Patients were categorized according to site of vessel occlusion into 4 distinct groups: proximal middle cerebral artery occlusion (n=251), distal middle cerebral artery occlusion (n=194), internal carotid artery bifurcation occlusion (n=61), and basilar artery occlusion (n=42). Recanalization was assessed on transcranial Doppler at 1 hour of tissue-type plasminogen activator bolus.
  
  
  RESULTS
  Among patients with proximal middle cerebral artery occlusion, the presence of severe extracranial internal carotid artery stenosis or occlusion (OR, 2.36; 95% CI, 1.15-4.84; P=0.02) and age >74 years (OR, 1.84; 95% CI, 1.02-3.31; P=0.04) independently predicted no recanalization. No independent predictors of no recanalization were identified in patients with distal middle cerebral artery occlusion. In patients with internal carotid artery bifurcation occlusion, a previous diagnosis of hypertension (OR, 12.77; 95% CI, 2.12-76.88; P=0.05), and absence of atrial fibrillation (OR, 8.15; 95% CI, 1.40-47.44; P=0.02) emerged as independent predictors of no recanalization. Similarly, among patients with basilar artery occlusion, absence of atrial fibrillation was as an independent predictor of no recanalization (OR, 7.50; 95% CI, 1.40-40.35; P=0.02).
  
  
  CONCLUSIONS
  The use of relevant predictors of no recanalization and a rapid neurovascular evaluation may improve the selection of patients for more aggressive rescue strategies.
authors.affiliation: Department of Neurology, University Hospital of Coimbra, Coimbra, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Mendonça
authors.forename: David
authors.initials: D
authors.lastname: Rodriguez-Luna
authors.forename: Marta
authors.initials: M
authors.lastname: Rubiera
authors.forename: Sandra
authors.initials: S
authors.lastname: Boned-Riera
authors.forename: Marc
authors.initials: M
authors.lastname: Ribo
authors.forename: Jorge
authors.initials: J
authors.lastname: Pagola
authors.forename: Socorro
authors.initials: S
authors.lastname: Piñeiro
authors.forename: Pilar
authors.initials: P
authors.lastname: Meler
authors.forename: Jose
authors.initials: J
authors.lastname: Alvarez-Sabin
authors.forename: Joan
authors.initials: J
authors.lastname: Montaner
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Molina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D002536:Cerebral Arteries / Q000473:pathology*; D004351:Drug Resistance; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy / Q000473:pathology; D020766:Intracranial Embolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D014715:Vertebrobasilar Insufficiency / Q000188:drug therapy / Q000473:pathology; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator