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Predictors of early arterial reocclusion after tissue plasminogen activator-induced recanalization in acute ischemic stroke.

Abstract：

BACKGROUND AND PURPOSE:We aimed to determine clinical and hemodynamic predictors of early reocclusion (RO) in stroke patients treated with intravenous tissue plasminogen activator (tPA). METHODS:We studied 142 consecutive stroke patients with a documented middle cerebral artery (MCA) occlusion treated with intravenous tPA. All patients underwent carotid ultrasound and transcranial Doppler (TCD) examination before tPA bolus. National Institutes of Health Stroke Scale (NIHSS) scores were performed at baseline and serially for <24 hours. TCD monitoring of MCA recanalization (RE) and RO was performed during the first 2 hours after tPA bolus and repeated when clinical deterioration occurred <24 hours after documented RE in absence of intracranial hemorrhage. RESULTS:After 1 hour of tPA administration, RE occurred in 84 (61%) patients (53 partial, 31 complete). Of these, 21 (25%) patients worsened after an initial improvement and 17 (12%) of them showed RO on TCD. RO was identified at a mean time of 65+/-55 minutes after documented RE. RO was associated (P=0.034) with a lower degree of 24-hour NIHSS score improvement than sustained RE, and a higher modified Rankin scale score at 3 months (P=0.002). Age older than 75 years (P=0.012), previous antiplatelet treatment (P=0.048), baseline NIHSS score >16 points (P=0.009), higher leukocytes count (P=0.042), beginning of RE <60 minutes after tPA bolus (P=0.039), and ipsilateral severe carotid stenosis/occlusion (P=0.001) were significantly associated with RO. In a logistic regression model, NIHSS score >16 at baseline (odds ratio [OR], 7.1; 95% CI, 1.3 to 32) and severe ipsilateral carotid disease (OR, 13.3; 95% CI, 3.2 to 54) remained as independent predictors of RO. CONCLUSIONS:Stroke severity and ipsilateral severe carotid artery disease independently predict RO after tPA-induced MCA RE.

journal_name

Stroke

journal_title

Stroke

authors

Rubiera M,Alvarez-Sabín J,Ribo M,Montaner J,Santamarina E,Arenillas JF,Huertas R,Delgado P,Purroy F,Molina CA

doi

10.1161/01.STR.0000170711.43405.81

subject

Has Abstract

pub_date

2005-07-01 00:00:00

pages

1452-6

issue

eissn

0039-2499

issn

1524-4628

pii

01.STR.0000170711.43405.81

journal_volume

pub_type

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Predictors of early arterial reocclusion after tissue plasminogen activator-induced recanalization in acute ischemic stroke.