title: Factors and outcomes associated with recanalization timing after thrombolysis.
abstract: BACKGROUND
  A substantial number of acute stroke patients do not respond immediately to aggressive intra-arterial (IA) recanalization therapy. The factors and outcomes associated with timing of recanalization after IA thrombolysis, however, have not yet been determined.
  
  
  METHODS
  Factors and outcomes in 75 acute ischemic stroke patients treated with IA urokinase (± intravenous tissue plasminogen activator) within 6 h of onset were retrospectively assessed. Immediate recanalization (IR) was assessed by the angiogram at the end of the IA procedure, and delayed (DR) and no (NR) recanalization were assessed by 5-day MR angiography. Modified Rankin Scale (mRS) scores were determined at 7 days and 3 months.
  
  
  RESULTS
  Of the 75 patients, 32 (42.7%) achieved IR, 21 (28%) achieved DR, and 22 (29.3%) showed NR. Good functional outcomes (mRS score ≤2) at 7 days and 3 months were observed in 59.4 and 62.5%, respectively, of the IR group, 14.3 and 38.1% of the DR group, and 22.7 and 27.3% of the NR group (p = 0.001 for 7 days, p = 0.028 for 3 months). Multivariate analysis showed that cardioembolism [odds ratio (OR), 3.74; 95% confidence interval (CI), 1.15-12.19] and middle cerebral artery occlusion (OR, 3.23; 95% CI, 1.04-10.04) were independent predictors of IR or DR compared with NR. Age (OR, 0.86; 95% CI, 0.77-0.95) and initial NIHSS score (OR, 1.20; 95% CI, 1.04-1.37) were independent predictors of DR compared with IR.
  
  
  CONCLUSIONS
  Patients receiving IA thrombolysis show different clinical and radiological characteristics according to the timing of recanalization. Earlier identification of DR patients and their more efficient recanalization may improve overall clinical outcomes after IA thrombolysis.
authors.affiliation: Stroke Center and Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung-Hee
authors.initials: KH
authors.lastname: Cho
authors.forename: Deok Hee
authors.initials: DH
authors.lastname: Lee
authors.forename: Sun U
authors.initials: SU
authors.lastname: Kwon
authors.forename: Choong Gon
authors.initials: CG
authors.lastname: Choi
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Kim
authors.forename: Dae-Chul
authors.initials: DC
authors.lastname: Suh
authors.forename: Jong S
authors.initials: JS
authors.lastname: Kim
authors.forename: Dong-Wha
authors.initials: DW
authors.lastname: Kang
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator