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Recanalization after thrombolysis in stroke patients

Predictors and prognostic implications

From the Departments of Neurology (A.Z., S.K., M.S., M.F., M.K., P.W., A.M., G.W., C.S., W.P., J.W.) and Diagnostic Radiology (K.G., T.G., S.F.), Innsbruck Medical University, Innsbruck, Austria.

Address correspondence and reprint requests to Johann Willeit, Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria; e-mail: Johann.willeit{at}uibk.ac.at

Objective: To estimate rates, predictors, and prognostic importance of recanalization in an unselected series of patients with stroke treated with IV thrombolysis.

Methods: We performed a CT angiography or transcranial Doppler (TCD) follow-up examination 24 hours after IV thrombolysis in 64 patients with documented occlusion of the intracranial internal carotid or middle cerebral artery (MCA). Complete recanalization was defined by a rating of 3 on the Thrombolysis in Myocardial Infarction or 4/5 on the Thrombolysis in Brain Ischemia grading scales. Information about risk factors, clinical features, and outcome was prospectively collected by standardized procedures.

Results: Complete recanalization was achieved in 36 of the 64 patients (56.3%). There was a nonsignificant trend of recanalization rates to decline with a more proximal site of occlusion: 68.4% (M2 segment of MCA), 53.1% (M1 segment), and 46.2% (carotid T) (p for trend = 0.28). Frequencies of vessel reopening were markedly reduced in subjects with diabetes (9.1% vs 66.0% in nondiabetics, p < 0.001) and less so in subjects with additional extracranial carotid occlusion (p = 0.03). Finally, complete recanalization predicted a favorable stroke outcome at day 90 independently of the information provided by age, NIH Stroke Scale, and onset-to-needle time.

Conclusions: We found a high rate of vessel recanalization after IV thrombolysis occlusion. However, recanalization was infrequent in patients with diabetes and extracranial carotid occlusion. Information on recanalization was a powerful, early predictor for clinical outcome.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the January 2 issue to find the title link for this article.

Disclosure: The authors report no conflicts of interest.

Received June 14, 2006. Accepted in final form September 27, 2006.

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