title: Timing of recanalization after intravenous thrombolysis and functional outcomes after acute ischemic stroke.
abstract: BACKGROUND
  Recanalization of occluded intracranial arteries remains the aim of intravenous (IV) tissue plasminogen activator (tPA) therapy in acute ischemic stroke (AIS).
  
  
  OBJECTIVE
  To examine the timing and impact of recanalization on functional outcomes in AIS.
  
  
  METHODS
  A longitudinal cohort of consecutive IV tPA–treated patients with AIS from January 2007 through December 2010. Data were collected for demography, risk factors, stroke subtypes, blood pressure, and National Institutes of Health Stroke Scale scores. Early recanalization (ER) was identified by transcranial Doppler monitoring during the first 2 hours of treatment. Recanalization was reevaluated at 24 hours by computed tomographic angiography (CTA). Patients with ER and patent index artery at 24 hours on CTA were labeled as having persistent recanalization (PR). Recanalization at 24 hours on CTA regardless of transcranial Doppler status was labeled as CTR. Favorable outcome was defined as a modified Rankin Scale score of 0 to 1 at 3 months.
  
  
  METHODS
  University hospital stroke center.
  
  
  METHODS
  A total of 240 patients with AIS who underwent IV tPA treatment.
  
  
  RESULTS
  Of 2238 patients with AIS, 240 (11%) received IV tPA. The median age was 65 years (range, 19-92 years) and 44% of the study group was male. The median National Institutes of Health Stroke Scale score was 17 (range, 3-35) and the median onset-to-treatment time was 149 minutes (range, 46-270 minutes). Of the 240 patients, 122 (50.8%) achieved favorable outcomes at 3 months. Data for ER, PR, and CTR were analyzed for 160 patients. Early recanalization was seen in 82 patients (51.3%); 67 cases (81.7%) had PR and 84 cases (52.5%) had CTR. National Institutes of Health Stroke Scale score at onset (odds ratio per 1-point increase, 0.938; 95% CI, 0.888-0.991), ER (odds ratio, 3.048; 95% CI, 1.537-6.046), PR (odds ratio, 5.449; 95% CI, 2.382-12.464), and CTR (odds ratio, 4.329; 95% CI, 2.131-8.794) were independent predictors of favorable outcomes.
  
  
  CONCLUSIONS
  Intravenous tPA–induced arterial recanalization within the first 24 hours in AIS is a strong predictor of favorable outcomes at 3 months.
authors.affiliation: Division of Neurology, Department of Medicine, National University Health System, Singapore, 1 E Kent Ridge Road, Singapore. leonard_ll_yeo@nuhs.edu.sg
authors.forename: Leonard L L
authors.initials: LL
authors.lastname: Yeo
authors.forename: Prakash
authors.initials: P
authors.lastname: Paliwal
authors.forename: Hock L
authors.initials: HL
authors.lastname: Teoh
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Seet
authors.forename: Bernard P L
authors.initials: BP
authors.lastname: Chan
authors.forename: Shen
authors.initials: S
authors.lastname: Liang
authors.forename: Narayanaswamy
authors.initials: N
authors.lastname: Venketasubramanian
authors.forename: Rahul
authors.initials: R
authors.lastname: Rathakrishnan
authors.forename: Aftab
authors.initials: A
authors.lastname: Ahmad
authors.forename: Kay W P
authors.initials: KW
authors.lastname: Ng
authors.forename: Pei K
authors.initials: PK
authors.lastname: Loh
authors.forename: Jonathan J Y
authors.initials: JJ
authors.lastname: Ong
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Wakerley
authors.forename: Vincent F
authors.initials: VF
authors.lastname: Chong
authors.forename: Girish
authors.initials: G
authors.lastname: Bathla
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Sharma
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010959:Tissue Plasminogen Activator