Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
Tsivgoulis, Georgios Saqqur, Maher Sharma, Vijay K Brunser, Alejandro Eggers, Juergen Mikulik, Robert Katsanos, Aristeidis H Sergentanis, Theodore N Vadikolias, Konstantinos Perren, Fabienne
Tsivgoulis, Georgios
Saqqur, Maher
Brunser, Alejandro
Eggers, Juergen
Mikulik, Robert
Katsanos, Aristeidis H
Sergentanis, Theodore N
Vadikolias, Konstantinos
Perren, Fabienne
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Alternative Title
Abstract
Background and Purpose Although onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable. Methods We conducted a multicenter, prospective observational cohort study to determine whether early (within 1-hour from tPA-bolus) complete or partial recanalization assessed during 2-hour real-time transcranial Doppler monitoring is associated with improved outcomes in patients with proximal occlusions. Outcome events included dramatic clinical recovery (DCR) within 2 and 24-hours from tPA-bolus, 3-month mortality, favorable functional outcome (FFO) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0–1 and 0–2 respectively. Results We enrolled 480 AIS patients (mean age 66±15 years, 60% men, baseline National Institutes of Health Stroke Scale score 15). Patients with early recanalization (53%) had significantly (P<0.001) higher rates of DCR at 2-hour (54% vs. 10%) and 24-hour (63% vs. 22%), 3-month FFO (67% vs. 28%) and FI (81% vs. 39%). Three-month mortality rates (6% vs. 17%) and distribution of 3-month mRS scores were significantly lower in the early recanalization group. After adjusting for potential confounders, early recanalization was independently associated with higher odds of 3-month FFO (odds ratio [OR], 6.19; 95% confidence interval [CI], 3.88 to 9.88) and lower likelihood of 3-month mortality (OR, 0.34; 95% CI, 0.17 to 0.67). Onset to treatment time correlated to the elapsed time between tPA-bolus and recanalization (unstandardized linear regression coefficient, 0.13; 95% CI, 0.06 to 0.19). Conclusions Earlier tPA treatment after stroke onset is associated with faster tPA-induced recanalization. Earlier onset-to-recanalization time results in improved functional recovery and survival in AIS patients with proximal intracranial occlusions.
Keywords
Science & Technology, Life Sciences & Biomedicine, Clinical Neurology, Peripheral Vascular Disease, Neurosciences & Neurology, Cardiovascular System & Cardiology, Thrombolysis, Stroke, Reperfusion, Outcomes, TISSUE-PLASMINOGEN ACTIVATOR, INTRAVENOUS THROMBOLYSIS, MECHANICAL THROMBECTOMY, TIME, REPERFUSION, IMPACT, OUTCOMES, MORTALITY, CRITERIA, THERAPY
Source Title
JOURNAL OF STROKE
Publisher
KOREAN STROKE SOC
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Date
2020-01-01
DOI
10.5853/jos.2019.01648
Type
Article