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 Volume 68, Number 17, April 24, 2007
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NEUROLOGY 2007;68:1364-1368
© 2007 American Academy of Neurology

Recanalization after intravenous thrombolysis

Does a recanalization time window exist?

M. T. Wunderlich, MD, PhD, M. Goertler, MD, PhD, T. Postert, MD, PhD, E. Schmitt, MD, G. Seidel, MD, PhD, G. Gahn, MD, PhD, C. Samii, MD, E. Stolz, MD, PhD For the Duplex Sonography in Acute Stroke (DIAS) Study Group and the Competence Network Stroke*

From the Department of Neurology (M.T.W., M.G.), University Hospital Magdeburg; Department of Neurology (T.P.), St.-Vincenz-Krankenhaus Paderborn; Department of Neurology (E. Schmitt), Katholisches Klinikum, Koblenz; Department of Neurology (G.S.), Univ. Hospital Schleswig-Holstein, Campus Luebeck; Department of Neurology (G.G.), Klinikum Carl Gustav Carus, Technical Univ. Dresden; Department of Neurology (C.S.), Alfried-Krupp-Krankenhaus Essen; and Department of Neurology (E. Stolz), Justus-Liebig-University Giessen, Germany.

Address correspondence and reprint requests to Priv.-Doz. Dr. med. Erwin Stolz, Department of Neurology, Justus-Liebig-University Giessen, Am Steg 14, 35385 Giessen, Germany Erwin.stolz{at}neuro.med.uni-giessen.de

Background: To evaluate the time course of major vessel recanalization under IV thrombolysis in relation to functional outcome in acute ischemic stroke.

Methods: A total of 99 patients with an acute anterior circulation vessel occlusion who underwent IV thrombolysis were included. All patients had a standardized admission and follow-up procedure. Color-coded duplex sonography was performed on admission, 30 minutes after thrombolysis, and at 6 and 24 hours after onset of symptoms. Recanalization was classified as complete, partial, and absent. Functional outcome was rated with the modified Rankin Scale on day 30.

Results: Complete recanalization occurred significantly more frequently in patients with multiple branch occlusions compared to those with mainstem occlusion (OR 5.33; 95% CI, 2.18 to 13.05; p < 0.0001) and was associated with lower NIH Stroke Scale (NIHSS) scores (p < 0.001). Not the specific time point of recanalization at 6 or 24 hours after stroke onset, but recanalization per se within 24 hours (OR 7.8; 95% CI 2.2 to 28.2; p = 0.002) was significantly associated with a favorable outcome. Multivariate analysis revealed recanalization at any time within 24 hours and NIHSS scores on days 1 and 7 together explaining 75% of the functional outcome variance 30 days after stroke.

Conclusions: Complete recanalization up to 24 hours after stroke onset is significantly associated with the short-term clinical course and functional outcome 30 days after acute stroke.

Editorial, see page 1335

Received August 11, 2006. Accepted in final form February 2, 2007.

Disclosure: All authors are members of the Ultrasound Subnet of the Competence Network Stroke and received funding by the German Federal Ministry of Education and Research (BMBF).


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