Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
Journal
Journal of Stroke
ISSN
2287-6391
2287-6405
Date Issued
2020
Author(s)
Georgios Tsivgoulis
Maher Saqqur
Vijay K. Sharma
Jürgen Eggers
Robert Mikulik
Aristeidis H. Katsanos
Theodore N. Sergentanis
Konstantinos Vadikolias
Fabienne Perren
Marta Rubiera
Reza Bavarsad Shahripour
Huy Thang Nguyen
Patricia Martínez-Sánchez
Apostolos Safouris
Ioannis Heliopoulos
Ashfaq Shuaib
Carol Derksen
Konstantinos Voumvourakis
Theodora Psaltopoulou
Anne W. Alexandrov
Andrei V. Alexandrov
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:p>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 (<i>P</i><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.</jats:p>
Subjects
thrombolysis
;
stroke
;
reperfusion
;
outcomes
;
tissue plasminogen activator
;
aged
;
article
;
brain ischemia
;
cerebrovascular accident
;
cohort analysis
;
convalescence
;
dramatic clinical recovery
;
favorable functional outcome
;
female
;
functional assessment
;
functional independence measure
;
functional outcome
;
functional recovery
;
human
;
major clinical study
;
male
;
mortality
;
mortality rate
;
national institutes of health stroke scale
;
observational study
;
occlusion
;
open study
;
outcome assessment
;
prospective study
;
rankin scale
;
recanalization