BACKGROUND AND PURPOSE: We aimed to evaluate the timing, speed, and degree of tissue plasminogen activator (tPA)-induced recanalization in patients with proximal middle cerebral artery (MCA) occlusion of different stroke subtypes. METHODS: We evaluated 72 patients with acute stroke caused by proximal MCA occlusion treated with intravenous tPA in <3 hours. Transcranial Doppler monitoring of recanalization was conducted during tPA infusion and at 6 hours. Strokes were categorized as large-vessel disease strokes, cardioembolic strokes, or strokes of undetermined origin according to Trial of Org 10172 in Acute Stroke Treatment criteria. RESULTS: During 1-hour tPA infusion, recanalization occurred in 34 patients (47%); 32% showed a sudden, 50% showed a stepwise, and 18% showed a slow pattern of recanalization. One-hour recanalization was more frequent in patients with cardioembolic stroke (59%) compared with large-vessel disease (8%) and undetermined origin (50%) strokes. A cardiac source of emboli was identified in 81% of patients who showed a sudden clot breakup during tPA infusion. Rate of complete recanalization at 6 hours was higher (P=0.006) in patients with cardioembolic stroke (50%) compared with other stroke subtypes (27%). Sudden recanalization was associated (P=0.002) with a higher degree of neurological improvement at 24 hours compared with stepwise, slow, and no recanalization. A graded response in long-term outcome was observed in relation to the speed of clot lysis during tPA administration. CONCLUSIONS: We demonstrate that the pattern of tPA-induced MCA recanalization differs among stroke subtypes. Early recanalization was more frequent, faster, and more complete in patients with cardioembolic stroke compared with other stroke subtypes.
BACKGROUND AND PURPOSE: We aimed to evaluate the timing, speed, and degree of tissue plasminogen activator (tPA)-induced recanalization in patients with proximal middle cerebral artery (MCA) occlusion of different stroke subtypes. METHODS: We evaluated 72 patients with acute stroke caused by proximal MCA occlusion treated with intravenous tPA in <3 hours. Transcranial Doppler monitoring of recanalization was conducted during tPA infusion and at 6 hours. Strokes were categorized as large-vessel disease strokes, cardioembolic strokes, or strokes of undetermined origin according to Trial of Org 10172 in Acute Stroke Treatment criteria. RESULTS: During 1-hour tPA infusion, recanalization occurred in 34 patients (47%); 32% showed a sudden, 50% showed a stepwise, and 18% showed a slow pattern of recanalization. One-hour recanalization was more frequent in patients with cardioembolic stroke (59%) compared with large-vessel disease (8%) and undetermined origin (50%) strokes. A cardiac source of emboli was identified in 81% of patients who showed a sudden clot breakup during tPA infusion. Rate of complete recanalization at 6 hours was higher (P=0.006) in patients with cardioembolic stroke (50%) compared with other stroke subtypes (27%). Sudden recanalization was associated (P=0.002) with a higher degree of neurological improvement at 24 hours compared with stepwise, slow, and no recanalization. A graded response in long-term outcome was observed in relation to the speed of clot lysis during tPA administration. CONCLUSIONS: We demonstrate that the pattern of tPA-induced MCA recanalization differs among stroke subtypes. Early recanalization was more frequent, faster, and more complete in patients with cardioembolic stroke compared with other stroke subtypes.
Authors: J M Niesten; I C van der Schaaf; G J Biessels; A E van Otterloo; T van Seeters; A D Horsch; M J A Luitse; Y van der Graaf; L J Kappelle; W P T M Mali; B K Velthuis Journal: Neuroradiology Date: 2013-06-21 Impact factor: 2.804
Authors: J Puig; S Pedraza; A Demchuk; J Daunis-I-Estadella; H Termes; G Blasco; G Soria; I Boada; S Remollo; J Baños; J Serena; M Castellanos Journal: AJNR Am J Neuroradiol Date: 2011-12-08 Impact factor: 3.825
Authors: G Gascou; K Lobotesis; P Machi; I Maldonado; J F Vendrell; C Riquelme; O Eker; G Mercier; I Mourand; C Arquizan; A Bonafé; V Costalat Journal: AJNR Am J Neuroradiol Date: 2013-10-24 Impact factor: 3.825
Authors: Jonathan T Sutton; Nikolas M Ivancevich; Stephen R Perrin; Deborah C Vela; Christy K Holland Journal: Ultrasound Med Biol Date: 2013-03-01 Impact factor: 2.998
Authors: Jonathan T Sutton; Kevin J Haworth; Gail Pyne-Geithman; Christy K Holland Journal: Expert Opin Drug Deliv Date: 2013-03-01 Impact factor: 6.648