title: Repeated intravenous thrombolysis after recurrent stroke. A case series and review of the literature.
abstract: BACKGROUND
  The likelihood of severe disability and death increases with each recurrent stroke. Repeated intravenous (IV) thrombolysis remains one of the therapeutic options when secondary prevention fails; however, its effects after recurrent stroke are largely unknown. The aim of the present review was to assess the risks and benefits of IV re-thrombolysis after recurrent stroke as compared with IV thrombolysis after index stroke.
  
  
  METHODS
  We identified 8 patients who repeated IV thrombolysis after recurrent stroke from among the 615 consecutive stroke patients who received IV thrombolysis at our Stroke Unit and 22 cases of IV re-thrombolysed patients extracted for the literature review of case reports and case series.
  
  
  RESULTS
  After excluding the 6 patients treated with endovascular procedures, we included in the analyses 21 patients for which we had data on pre-stroke functional status and baseline neurological severity for each stroke event and post-treatment functional status for each IV thrombolysis. We compared second (n=21) and third (n=3) IV thrombolytic treatments with first IV thrombolytic treatments (n=21). Also, we compared IV thrombolytic re-treatments ≤3 months from previous IV thrombolysis (n=10) with those >3 months (n=14). No significant differences in the rate of intracranial hemorrhage with neurological deterioration, mortality and restitution of the pre-existing functional status were observed in the comparative analyses.
  
  
  CONCLUSIONS
  IV re-thrombolysis may be safe and effective when recurrent stroke occurs after a period of complete neurologic regression lasting at least 24h or minor disability (mRS score ≤2) lasting at least 3 months since the previous stroke.
authors.affiliation: Stroke Unit, Division of Neurology, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy. Electronic address: manuel_cappellari@libero.it.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cappellari
authors.affiliation: Stroke Unit, Division of Neurology, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Moretto
authors.affiliation: Stroke Unit, Division of Neurology, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bovi
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*
chemical_list: D005343:Fibrinolytic Agents
keywords: Alteplase; Fibrinolysis; Recombinant tissue-type plasminogen activator; Recurrent stroke; Repeated; Thrombolysis