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[Prognostic impact of time-point and degree of arterial recanalization of acute middle cerebral artery occlusions after intravenous tPA administration].

Abstract：

BACKGROUND AND OBJECTIVE:We aimed to evaluate the prognostic impact of the degree and time-point of arterial recanalization during the first 24h after tPA administration in patients with acute middle cerebral artery (MCA) occlusions. PATIENTS AND METHOD:We prospectively studied consecutive ischemic stroke patients treated with i.v. tPA following SITS-MOST criteria, who showed MCA occlusions on pre-bolus transcranial Duplex (TCCD) examinations. TCCD recordings were obtained 1, 2, 6, 12 and 24h after t-PA treatment. Thrombolysis in Brain Ischemia criteria were used to define complete, partial or absent MCA recanalization at each time point. Early neurological improvement (ENI) was defined as a decrease in 4 points in the NIHSS score during the first 24h. A modified Rankin scale score 2 at day 90 was considered indicative of good long-term clinical outcome. RESULTS:A total of 61 patients were included. Median baseline NIHSS score was 13 (interquartile range 9-18). ENI was observed in 32 (53%) patients. Complete, but not partial, recanalization at any time-point was independently associated with ENI in adjusted logistic regression models. The probability of ENI was maximal for <1h complete recanalization (OR 14.7, 95% CI [1.9-109.2], P=.009) and gradually decreased with later time-points. Thirty-five (57%) patients showed good long-term outcome. Both partial and complete MCA recanalizations achieved at any time-point during the first 12h after tPA bolus were independently associated with a good outcome. Odds ratio for favourable outcome was maximal (OR 33.7, 95% CI [2.2-520]; P=.012) when recanalization was achieved during tPA infusion. CONCLUSIONS:Any degree of MCA recanalization observed during the first 12h following tPA administration predicted good long-term outcomes. Only complete recanalization was associated with early neurological improvement.

journal_name

Med Clin (Barc)

journal_title

Medicina clinica

authors

Dorado L,Arenillas JF,Millán M,Pérez De La Ossa N,Guerrero C,Dávalos A

doi

10.1016/j.medcli.2008.06.029

subject

Has Abstract

pub_date

2009-05-02 00:00:00

pages

609-15

issue

eissn

0025-7753

issn

1578-8989

pii

S0025-7753(09)00513-2

journal_volume

132

pub_type

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[Prognostic impact of time-point and degree of arterial recanalization of acute middle cerebral artery occlusions after intravenous tPA administration].