Late recanalisation beyond 24 hours is associated with worse outcome: an observational study.
OBJECTIVE
We evaluated the rate of late recanalisation beyond 24 h after intravenous thrombolysis (IVT) and its relationship with haemorrhagic transformation and outcome.


METHODS
We reviewed prospectively collected clinical and imaging data from acute ischaemic stroke patients with distal internal carotid artery or proximal middle cerebral artery occlusion who underwent angiography on admission, 24 h and 1 week after IVT. Patients were trichotomised according to vascular status: timely recanalisation (<24 h), late recanalisation (24 h-7 days), and no recanalisation.


RESULTS
Non-invasive angiography revealed timely recanalisation in 52 (50.0 %) patients, late recanalisation in 25 (24.0 %) patients, and no recanalisation in 27 (26.0 %) patients. Pre-existing atrial fibrillation was associated with the occurrence of late recanalisation (odds ratio 6.674; 95 % CI: 1.197 to 37.209; p = 0.030). In patients without timely recanalisation, shift analysis indicated that late recanalisation led to a worse modified Rankin Scale score (odds ratio 6.787; 95 % CI: 2.094 to 21.978; p = 0.001).


CONCLUSIONS
About half of all patients without recanalisation by 24 h after IVT may develop late recanalisation within 1 week, along with higher mRS scores by 3 months. Pre-existing atrial fibrillation is an independent predictor for late recanalisation.


CONCLUSIONS
• About half of patients may develop late recanalisation within 1 week. • Pre-existing atrial fibrillation was associated with the occurrence of late recanalisation. • Late recanalisation led to a higher mRS score than no recanalisation.
Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China.
Shenqiang
S
Yan
Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China.
Mengjun
M
Xu
Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China.
Quan
Q
Han
Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China.
Keqi
K
Ye
Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China.
Yangxiao
Y
Lai
Department of Neurology, Hangzhou First People's Hospital, Hangzhou, China.
Keqin
K
Liu
University of California-Los Angeles Stroke Center, Los Angeles, CA, USA.
David S
DS
Liebeskind
Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, China. loumingxc@vip.sina.com.
Min
M
Lou
D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002533:Cerebral Angiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
Angiography; Middle cerebral artery occlusion; Outcome assessment; Stroke; Thrombolytic therapy