Atrial fibrillation as an independent predictor for no early recanalization after IV-t-PA in acute ischemic stroke

J Neurol Sci. 2008 Apr 15;267(1-2):57-61. doi: 10.1016/j.jns.2007.09.036. Epub 2007 Oct 26.


Background and purpose: Intravenous administration of tissue plasminogen activator (t-PA) dissolves the clot and can improve clinical outcome in patients with acute ischemic stroke. However, lack of early recanalization frequently does not result in good outcome.

Methods: We prospectively studied acute stroke patients treated with t-PA and examined clinical factors associated with no early recanalization of occluded arteries after t-PA administration using serial magnetic resonance angiography (MRA). NIHSS score was obtained before and at 24h after t-PA administration.

Results: Subjects comprised 49 consecutive stroke patients treated with t-PA. Initial MRA before t-PA infusion demonstrated occluded arteries in 37 patients. Of the 37 occluded arteries, follow-up MRA within 30min after t-PA administration revealed complete recanalization in 6 patients, partial recanalization in 12, and no early recanalization in 19. Neurological worsening (total NIHSS score increased by > or =4) occurred in 0 of 18 patients with recanalization and 4 of 19 patients with no recanalization (P=0.039). Atrial fibrillation (AF) and hypertension were more frequent in patients with non-early recanalization than in patients with recanalization (73.7% vs. 38.9%, P=0.03; 73.6% vs. 38.9%, P=0.03, respectively). However, no differences were observed in other clinical factors between groups. Multivariate logistic regression analysis demonstrated AF (OR: 9.3; CI: 1.5-55.8, P=0.015) as the only independent factor associated with no recanalization.

Conclusion: No early recanalization after t-PA administration was observed in 51.4% of acute stroke patients with occluded arteries and was significantly associated with neurological worsening. AF was independently associated with no recanalization after t-PA administration.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / diagnosis*
  • Brain Ischemia / complications
  • Brain Ischemia / drug therapy*
  • Brain Ischemia / physiopathology
  • Cerebral Arteries / drug effects
  • Cerebral Arteries / pathology
  • Cerebral Arteries / physiopathology
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Humans
  • Injections, Intravenous
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Stroke / complications
  • Stroke / drug therapy*
  • Stroke / physiopathology
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage*
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator